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Anand A, Castiglia E, Zamora ML. The Association Between Personal Air Pollution Exposures and Fractional Exhaled Nitric Oxide (FeNO): A Systematic Review. Curr Environ Health Rep 2024; 11:210-224. [PMID: 38386269 PMCID: PMC11180488 DOI: 10.1007/s40572-024-00430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE OF REVIEW Airway inflammation is a common biological response to many types of environmental exposures and can lead to increased nitric oxide (NO) concentrations in exhaled breath. In recent years, several studies have evaluated airway inflammation using fractional exhaled nitric oxide (FeNO) as a biomarker of exposures to a range of air pollutants. This systematic review aims to summarize the studies that collected personal-level air pollution data to assess the air pollution-induced FeNO responses and to determine if utilizing personal-level data resulted in an improved characterization of the relationship between air pollution exposures and FeNO compared to using only ambient air pollution exposure data. RECENT FINDINGS Thirty-six eligible studies were identified. Overall, the studies included in this review establish that an increase in personal exposure to particulate and gaseous air pollutants can significantly increase FeNO. Nine out of the 12 studies reported statistically significant FeNO increases with increasing personal PM2.5 exposures, and up to 11.5% increase in FeNO per IQR increase in exposure has also been reported between FeNO and exposure to gas-phase pollutants, such as ozone, NO2, and benzene. Furthermore, factors such as chronic respiratory diseases, allergies, and medication use were found to be effect modifiers for air pollution-induced FeNO responses. About half of the studies that compared the effect estimates using both personal and ambient air pollution exposure methods reported that only personal exposure yielded significant associations with FeNO response. The evidence from the reviewed studies confirms that FeNO is a sensitive biomarker for air pollutant-induced airway inflammation. Personal air pollution exposure assessment is recommended to accurately assess the air pollution-induced FeNO responses. Furthermore, comprehensive adjustments for the potential confounding factors including the personal exposures of the co-pollutants, respiratory disease status, allergy status, and usage of medications for asthma and allergies are recommended while assessing the air pollution-induced FeNO responses.
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Affiliation(s)
- Abhay Anand
- Department of Public Health Sciences, UConn School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
| | - Elliana Castiglia
- Department of Public Health Sciences, UConn School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA
| | - Misti Levy Zamora
- Department of Public Health Sciences, UConn School of Medicine, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030-6325, USA.
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Masood M, Singh P, Hariss D, Khan F, Yameen D, Siraj S, Islam A, Dohare R, Mahfuzul Haque M. Nitric oxide as a double-edged sword in pulmonary viral infections: Mechanistic insights and potential therapeutic implications. Gene 2024; 899:148148. [PMID: 38191100 DOI: 10.1016/j.gene.2024.148148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/21/2023] [Accepted: 01/05/2024] [Indexed: 01/10/2024]
Abstract
In the face of the global pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), researchers are tirelessly exploring novel therapeutic approaches to combat coronavirus disease 2019 (COVID-19) and its associated complications. Nitric oxide (NO) has appeared as a multifaceted signaling mediator with diverse and often contrasting biological activities. Its intricate biochemistry renders it a crucial regulator of cardiovascular and pulmonary functions, immunity, and neurotransmission. Perturbations in NO production, whether excessive or insufficient, contribute to the pathogenesis of various diseases, encompassing cardiovascular disease, pulmonary hypertension, asthma, diabetes, and cancer. Recent investigations have unveiled the potential of NO donors to impede SARS-CoV- 2 replication, while inhaled NO demonstrates promise as a therapeutic avenue for improving oxygenation in COVID-19-related hypoxic pulmonary conditions. Interestingly, NO's association with the inflammatory response in asthma suggests a potential protective role against SARS-CoV-2 infection. Furthermore, compelling evidence indicates the benefits of inhaled NO in optimizing ventilation-perfusion ratios and mitigating the need for mechanical ventilation in COVID-19 patients. In this review, we delve into the molecular targets of NO, its utility as a diagnostic marker, the mechanisms underlying its action in COVID-19, and the potential of inhaled NO as a therapeutic intervention against viral infections. The topmost significant pathway, gene ontology (GO)-biological process (BP), GO-molecular function (MF) and GO-cellular compartment (CC) terms associated with Nitric Oxide Synthase (NOS)1, NOS2, NOS3 were arginine biosynthesis (p-value = 1.15 x 10-9) regulation of guanylate cyclase activity (p-value = 7.5 x 10-12), arginine binding (p-value = 2.62 x 10-11), vesicle membrane (p-value = 3.93 x 10-8). Transcriptomics analysis further validates the significant presence of NOS1, NOS2, NOS3 in independent COVID-19 and pulmonary hypertension cohorts with respect to controls. This review investigates NO's molecular targets, diagnostic potentials, and therapeutic role in COVID-19, employing bioinformatics to identify key pathways and NOS isoforms' significance.
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Affiliation(s)
- Mohammad Masood
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Prithvi Singh
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Daaniyaal Hariss
- Department of Biosciences, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Faizya Khan
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Daraksha Yameen
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Seerat Siraj
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Asimul Islam
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Ravins Dohare
- Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India.
| | - Mohammad Mahfuzul Haque
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia, New Delhi 110025, India.
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McCrossan P, Shields MD, McElnay JC. Medication Adherence in Children with Asthma. Patient Prefer Adherence 2024; 18:555-564. [PMID: 38476591 PMCID: PMC10929205 DOI: 10.2147/ppa.s445534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
Asthma is the most common chronic disease in childhood. If untreated, asthma can lead to debilitating daily symptoms which affect quality of life, but more importantly can lead to fatal asthma attacks which unfortunately still occur globally. The most effective treatment strategy for controlling asthma is for the patient to follow a personalised asthma action plan (PAAP) which will invariably include regular use of an inhaled corticosteroid. To examine medication adherence in children with asthma, we collated recent evidence from systematic reviews in this area to address the following 5 key questions; What is adherence? Is there evidence that children are not adhering to preventer medication? Why is adherence poor and what are the barriers to adherence? Does good adherence improve outcomes in asthma? And lastly, how can treatment adherence be improved?
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Affiliation(s)
- Paddy McCrossan
- Paediatric Respiratory Medicine, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
| | - Michael D Shields
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - James C McElnay
- School of Pharmacy, Queen’s University Belfast, Belfast, Northern Ireland
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Rebrova S, Emelyanov A, Sergeeva G, Korneenkov A. Markers of eosinophilic airway inflammation in patients with asthma and allergic rhinitis. Allergy Asthma Proc 2024; 45:e9-e13. [PMID: 38151732 DOI: 10.2500/aap.2024.45.230077] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Background: Measurement of airway inflammation is an important step to determine phenotype of asthma and allergic rhinitis (AR). Objective: To assess the level of nitric oxide in exhaled air (FeNO), nasal fraction of nitric oxide (nasal NO), their relationship with clinical control and blood eosinophils in patients with steroid-naive mild and moderate asthma and AR. Methods: One hundred forty-seven patients (65 men), ages 26-49.5 years (mean age, 32 years) with AR (n = 81) or AR and concomitant asthma (n = 46) and 20 healthy subjects were included in a single-center cohort study. All the patients underwent spirometry with reversibility test. Control of asthma and AR was assessed by using the Asthma Control Questionnaire and the visual analog scale, respectively. Levels of FeNO and nasal NO were measured by chemiluminescent analyzer, peripheral blood eosinophils were counted by automatic analyzer. Results: The FeNO level was significantly elevated in the patients with asthma and concomitant AR compared with the healthy subjects and was associated with control of both asthma and AR. There was no correlation between nasal NO and control of AR. Receiver operating characteristic analysis revealed that the level of eosinophils of 150 cells/μL may be a cutoff for lower airway eosinophilic inflammation. Blood eosinophils count was unable to distinguish eosinophilic and non-eosinophilic upper airway inflammation. Conclusion: We confirm that FeNO but not nasal NO is a marker of eosinophilic airway inflammation in patients with mild-moderate steroid-naive AR and concomitant asthma. A blood eosinophil level of ≥150 cells/µL may be a simple marker of eosinophilic airway inflammation in patients with asthma. However, its low specificity requires repeated measurements and use in combination with other biomarkers.
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Affiliation(s)
- Svetlana Rebrova
- From the Saint-Petersburg Scientific Research Institute of Ear, Throat, Nose and Speech, Saint-Petersburg, Russia, and
| | - Alexander Emelyanov
- Department of Respiratory Medicine, North-Western Medical University named I.I. Mechnikov, Saint-Petersburg, Russia
| | - Galina Sergeeva
- Department of Respiratory Medicine, North-Western Medical University named I.I. Mechnikov, Saint-Petersburg, Russia
| | - Alexey Korneenkov
- From the Saint-Petersburg Scientific Research Institute of Ear, Throat, Nose and Speech, Saint-Petersburg, Russia, and
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Fraser A, Simpson R, Turner S. Use of exhaled nitric oxide in the diagnosis and monitoring of childhood asthma: myth or maxim? Breathe (Sheff) 2023; 19:220236. [PMID: 38125803 PMCID: PMC10729813 DOI: 10.1183/20734735.0236-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/14/2023] [Indexed: 12/23/2023] Open
Abstract
Asthma is a common condition in children. This review describes the evidence from the literature and international asthma guidelines for using fractional exhaled nitric oxide (FENO) in the diagnosis and monitoring of childhood asthma. The accuracy of FENO measuring devices could be further improved, the difference in FENO results between devices are equivalent to what is considered a clinically important difference. For diagnosing asthma no guideline currently recommends FENO is used as the first test, but many recommend FENO as part of a series of tests. A cut-off of 35 ppb is widely recommended as being supportive of an asthma diagnosis, but evidence from children at risk of asthma suggests that a lower threshold of 25 ppb may be more appropriate. Nine randomised clinical trials including 1885 children have added FENO to usual asthma care and find that exacerbations are reduced when care is guided by FENO (OR for exacerbation compared to usual care 0.77, 95% CI 0.62-0.94). What is not clear is what cut-off(s) of FENO should be used to trigger a change in treatment. After 30 years of intensive research there is not sufficient evidence to recommend FENO for routine diagnosing and monitoring asthma in children. Educational aims To give the reader an overview of literature that supports and does not support the role of FENO in diagnosing asthma in children.To give the reader an overview of literature that supports and does not support the role of FENO in monitoring asthma in children.To give the reader an understanding of the role of FENO in international guidelines for diagnosing and monitoring asthma in children.
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Affiliation(s)
- Anna Fraser
- Child Health, Women and Children's Division, NHS Grampian, Aberdeen, UK
- Joint first authors
| | - Ruaraidh Simpson
- Child Health, Women and Children's Division, NHS Grampian, Aberdeen, UK
- Joint first authors
| | - Steve Turner
- Child Health, Women and Children's Division, NHS Grampian, Aberdeen, UK
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Dharra R, Kumar Sharma A, Datta S. Emerging aspects of cytokine storm in COVID-19: The role of proinflammatory cytokines and therapeutic prospects. Cytokine 2023; 169:156287. [PMID: 37402337 PMCID: PMC10291296 DOI: 10.1016/j.cyto.2023.156287] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/24/2023] [Indexed: 07/06/2023]
Abstract
COVID-19 has claimed millions of lives during the last 3 years since initial cases were reported in Wuhan, China, in 2019. Patients with COVID-19 suffer from severe pneumonia, high fever, acute respiratory distress syndrome (ARDS), and multiple-organ dysfunction, which may also result in fatality in extreme cases. Cytokine storm (CS) is hyperactivation of the immune system, wherein the dysregulated production of proinflammatory cytokines could result in excessive immune cell infiltrations in the pulmonary tissues, resulting in tissue damage. The immune cell infiltration could also occur in other tissues and organs and result in multiple organs' dysfunction. The key cytokines implicated in the onset of disease severity include TNF-α, IFN-γ, IL-6, IL-1β, GM-CSF, and G-CSF. Controlling the CS is critical in treating COVID-19 disease. Therefore, different strategies are employed to mitigate the effects of CS. These include using monoclonal antibodies directed against soluble cytokines or the cytokine receptors, combination therapies, mesenchymal stem cell therapy, therapeutic plasma exchange, and some non-conventional treatment methods to improve patient immunity. The current review describes the role/s of critical cytokines in COVID-19-mediated CS and the respective treatment modalities.
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Affiliation(s)
- Renu Dharra
- CSIR-Institute of Microbial Technology, Sector 39 A, Chandigarh 160036, India
| | - Anil Kumar Sharma
- Department of Bio-Science and Technology, M. M. Engineering College, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala 133207, India
| | - Sonal Datta
- Department of Bio-Science and Technology, M. M. Engineering College, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala 133207, India.
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Aghamohamadi N, Shahba F, Zarezadeh Mehrabadi A, Khorramdelazad H, Karimi M, Falak R, Emameh RZ. Age-dependent immune responses in COVID-19-mediated liver injury: focus on cytokines. Front Endocrinol (Lausanne) 2023; 14:1139692. [PMID: 37654571 PMCID: PMC10465349 DOI: 10.3389/fendo.2023.1139692] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is potentially pathogenic and causes severe symptoms; in addition to respiratory syndromes, patients might experience other severe conditions such as digestive complications and liver complications injury. The abnormality in the liver is manifested by hepatobiliary dysfunction and enzymatic elevation, which is associated with morbidity and mortality. The direct cytopathic effect, immune dysfunction, cytokine storm, and adverse effects of therapeutic regimens have a crucial role in the severity of liver injury. According to aging and immune system alterations, cytokine patterns may also change in the elderly. Moreover, hyperproduction of cytokines in the inflammatory response to SARS-CoV-2 can lead to multi-organ dysfunction. The mortality rate in elderly patients, particularly those with other comorbidities, is also higher than in adults. Although the pathogenic effect of SARS-CoV-2 on the liver has been widely studied, the impact of age and immune-mediated responses at different ages remain unclear. This review discusses the association between immune system responses in coronavirus disease 2019 (COVID-19) patients of different ages and liver injury, focusing on cytokine alterations.
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Affiliation(s)
- Nazanin Aghamohamadi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Faezeh Shahba
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Zarezadeh Mehrabadi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hossein Khorramdelazad
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Immunology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Milad Karimi
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Falak
- Department of Immunology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Zolfaghari Emameh
- Department of Energy and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology (NIGEB), Tehran, Iran
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Ruan Y, Yuan PP, Li PY, Chen Y, Fu Y, Gao LY, Wei YX, Zheng YJ, Li SF, Feng WS, Zheng XK. Tingli Dazao Xiefei Decoction ameliorates asthma in vivo and in vitro from lung to intestine by modifying NO-CO metabolic disorder mediated inflammation, immune imbalance, cellular barrier damage, oxidative stress and intestinal bacterial disorders. JOURNAL OF ETHNOPHARMACOLOGY 2023; 313:116503. [PMID: 37116727 DOI: 10.1016/j.jep.2023.116503] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/01/2023] [Accepted: 04/15/2023] [Indexed: 05/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Asthma is a chronic airway inflammatory disease. Current treatment of mainstream medications has significant side effects. There is growing evidence that the refractoriness of asthma is closely related to common changes in the lung and intestine. The lungs and intestines, as sites of frequent gas exchange in the body, are widely populated with gas signaling molecules NO and CO, which constitute NO-CO metabolism and may be relevant to the pathogenesis of asthma in the lung and intestine. The Chinese herbal formula Tingli Dazao Xiefei Decoction (TD) is commonly used in clinical practice to treat asthma with good efficacy, but there are few systematic evaluations of the efficacy of asthma on NO-CO metabolism, and the mode of action of its improving effect on the lung and intestine is unclear. AIM OF THE STUDY To investigate the effect of TD on the lung and intestine of asthmatic rats based on NO-CO metabolism. MATERIALS AND METHODS In vivo, we established a rat asthma model by intraperitoneal injection of sensitizing solution with OVA atomization, followed by intervention by gavage administration of TD. We simultaneously examined alterations in basal function, pathology, NO-CO metabolism, inflammation and immune cell homeostasis in the lungs and intestines of asthmatic rats, and detected changes in intestinal flora by macrogenome sequencing technology, with a view to multi-angle evaluation of the treatment effects of TD on asthmatic rats. In vitro, lung cells BEAS-2B and intestinal cells NCM-460 were used to establish a model of lung injury causing intestinal injury using LPS and co-culture chambers, and lung cells or intestinal cells TD-containing serum was administered to intervene. Changes in inflammatory, NO-CO metabolism-related, cell barrier-related and oxidative stress indicators were measured in lung cells and intestinal cells to evaluate TD on intestinal injury by way of amelioration and in-depth mechanism. RESULTS In vivo, our results showed significant basal functional impairment in the lung and intestine of asthmatic rats, and an inflammatory response, immune cell imbalance and intestinal flora disturbance elicited by NO-CO metabolic disorders were observed (P < 0.05 or 0.01). The administration of TD was shown to deliver a multidimensional amelioration of the impairment induced by NO-CO metabolic disorders (P < 0.05 or 0.01). In vitro, the results showed that LPS-induced lung cells BEAS-2B injury could cause NO-CO metabolic disorder-induced inflammatory response, cell permeability damage and oxidative stress damage in intestinal cells NCM-460 (P < 0.01). The ameliorative effect on intestinal cells NCM-460 could only be exerted when TD-containing serum interfered with lung cells BEAS-2B (P < 0.01), suggesting that the intestinal ameliorative effect of TD may be exerted indirectly through the lung. CONCLUSION TD can ameliorate NO-CO metabolism in the lung and thus achieve the indirectly amelioration of NO-CO metabolism in the intestine, ultimately achieving co-regulation of lung and intestinal inflammation, immune imbalance, cellular barrier damage, oxidative stress and intestinal bacterial disorders in asthma in vivo and in vitro. Targeting lung and intestinal NO-CO metabolic disorders in asthma may be a new therapeutic idea and strategy for asthma.
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Affiliation(s)
- Yuan Ruan
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450008, China.
| | - Pei-Pei Yuan
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450008, China; The Engineering and Technology Center for Chinese Medicine Development of Henan Province, Zhengzhou, 450046, PR China.
| | - Pan-Ying Li
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450008, China.
| | - Yi Chen
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450008, China.
| | - Yang Fu
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450008, China.
| | - Li-Yuan Gao
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450008, China.
| | - Ya-Xin Wei
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450008, China.
| | - Ya-Juan Zheng
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450008, China.
| | - Sai-Fei Li
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450008, China.
| | - Wei-Sheng Feng
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450008, China; The Engineering and Technology Center for Chinese Medicine Development of Henan Province, Zhengzhou, 450046, PR China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R., Zhengzhou, 450008, China.
| | - Xiao-Ke Zheng
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, 450008, China; The Engineering and Technology Center for Chinese Medicine Development of Henan Province, Zhengzhou, 450046, PR China; Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases Co-constructed by Henan Province & Education Ministry of P. R., Zhengzhou, 450008, China.
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Gvalani A, Athavale A, Gupta D. Biomarkers in severe asthma: Identifying the treatable trait. Lung India 2023; 40:59-67. [PMID: 36695260 PMCID: PMC9894287 DOI: 10.4103/lungindia.lungindia_271_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/24/2022] [Accepted: 08/08/2022] [Indexed: 01/01/2023] Open
Abstract
Asthma is a chronic condition of bronchial hyper-reactivity associated with inflammation ranges from mild to severe form. It affects 1 - 18% of the population globally and it is estimated that > 300million people in the world have asthma. Of this 5 - 10% have severe asthma. while the proportion of patients suffering from severe are smaller, the morbidity and mortality are higher in this group. With the advances in our understanding of the pathophysiology of asthma there is a need to understand the role of various biomarkers. We live in an era of precision medicine and today there is a clear unmet need to understand targeted therapies. This review aims to raise awareness to the available biomarkers used in clinical practice in India and their role in predicting response to targeted therapies.
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Affiliation(s)
- Aanchal Gvalani
- Medical Affairs, GlaxoSmithKline, Mumbai, Maharashtra, India
| | - Amita Athavale
- Department of Pulmonary Medicine and EPRC, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Disha Gupta
- Medical Affairs, GlaxoSmithKline, Mumbai, Maharashtra, India
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Effect of General Anesthesia Maintenance with Propofol or Sevoflurane on Fractional Exhaled Nitric Oxide and Eosinophil Blood Count: A Prospective, Single Blind, Randomized, Clinical Study on Patients Undergoing Thyroidectomy. J Pers Med 2022; 12:jpm12091455. [PMID: 36143240 PMCID: PMC9505258 DOI: 10.3390/jpm12091455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Nitric oxide (NO) is considered a means of detecting airway hyperresponsiveness, since even non-asthmatic patients experiencing bronchospasm intraoperatively or postoperatively display higher levels of exhaled NO. It can also be used as a non-invasive biomarker of lung inflammation and injury. This prospective, single-blind, randomized study aimed to evaluate the impact of two different anesthesia maintenance techniques on fractional exhaled nitric oxide (FeΝO) in patients without respiratory disease undergoing total thyroidectomy under general anesthesia. Methods: Sixty patients without respiratory disease, atopy or known allergies undergoing total thyroidectomy were randomly allocated to receive either inhalational anesthesia maintenance with sevoflurane at a concentration that maintained Bispectral Index (BIS) values between 40 and 50 intraoperatively or intravenous anesthesia maintenance with propofol 1% targeting the same BIS values. FeΝO was measured immediately preoperatively (baseline), postoperatively in the Postanesthesia Care Unit and at 24 h post-extubation with a portable device. Other variables measured were eosinophil blood count preoperatively and postoperatively and respiratory parameters intraoperatively. Results: Patients in both groups presented lower than baseline values of FeΝO measurements postoperatively, which returned to baseline measurements at 24 h post-extubation. In the peripheral blood, a decrease in the percentage of eosinophils was demonstrated, which was significant only in the propofol group. Respiratory lung mechanics were better maintained in the propofol group as compared to the sevoflurane group. None of the patients suffered intraoperative bronchospasm. Conclusions: Both propofol and sevoflurane lead to the temporary inhibition of NO exhalation. They also seem to attenuate systemic hypersensitivity response by reducing the eosinophil count in the peripheral blood, with propofol displaying a more pronounced effect and ensuring a more favorable mechanical ventilation profile as compared to sevoflurane. The attenuation of NO exhalation by both agents may be one of the underlying mechanisms in the reduction in airway hyperreactivity. The clinical significance of this fluctuation remains to be studied in patients with respiratory disease.
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Beirag N, Kumar C, Madan T, Shamji MH, Bulla R, Mitchell D, Murugaiah V, Neto MM, Temperton N, Idicula-Thomas S, Varghese PM, Kishore U. Human surfactant protein D facilitates SARS-CoV-2 pseudotype binding and entry in DC-SIGN expressing cells, and downregulates spike protein induced inflammation. Front Immunol 2022; 13:960733. [PMID: 35967323 PMCID: PMC9367475 DOI: 10.3389/fimmu.2022.960733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Lung surfactant protein D (SP-D) and Dendritic cell-specific intercellular adhesion molecules-3 grabbing non-integrin (DC-SIGN) are pathogen recognising C-type lectin receptors. SP-D has a crucial immune function in detecting and clearing pulmonary pathogens; DC-SIGN is involved in facilitating dendritic cell interaction with naïve T cells to mount an anti-viral immune response. SP-D and DC-SIGN have been shown to interact with various viruses, including SARS-CoV-2, an enveloped RNA virus that causes COVID-19. A recombinant fragment of human SP-D (rfhSP-D) comprising of α-helical neck region, carbohydrate recognition domain, and eight N-terminal Gly-X-Y repeats has been shown to bind SARS-CoV-2 Spike protein and inhibit SARS-CoV-2 replication by preventing viral entry in Vero cells and HEK293T cells expressing ACE2. DC-SIGN has also been shown to act as a cell surface receptor for SARS-CoV-2 independent of ACE2. Since rfhSP-D is known to interact with SARS-CoV-2 Spike protein and DC-SIGN, this study was aimed at investigating the potential of rfhSP-D in modulating SARS-CoV-2 infection. Coincubation of rfhSP-D with Spike protein improved the Spike Protein: DC-SIGN interaction. Molecular dynamic studies revealed that rfhSP-D stabilised the interaction between DC-SIGN and Spike protein. Cell binding analysis with DC-SIGN expressing HEK 293T and THP- 1 cells and rfhSP-D treated SARS-CoV-2 Spike pseudotypes confirmed the increased binding. Furthermore, infection assays using the pseudotypes revealed their increased uptake by DC-SIGN expressing cells. The immunomodulatory effect of rfhSP-D on the DC-SIGN: Spike protein interaction on DC-SIGN expressing epithelial and macrophage-like cell lines was also assessed by measuring the mRNA expression of cytokines and chemokines. RT-qPCR analysis showed that rfhSP-D treatment downregulated the mRNA expression levels of pro-inflammatory cytokines and chemokines such as TNF-α, IFN-α, IL-1β, IL- 6, IL-8, and RANTES (as well as NF-κB) in DC-SIGN expressing cells challenged by Spike protein. Furthermore, rfhSP-D treatment was found to downregulate the mRNA levels of MHC class II in DC expressing THP-1 when compared to the untreated controls. We conclude that rfhSP-D helps stabilise the interaction between SARS- CoV-2 Spike protein and DC-SIGN and increases viral uptake by macrophages via DC-SIGN, suggesting an additional role for rfhSP-D in SARS-CoV-2 infection.
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Affiliation(s)
- Nazar Beirag
- Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Chandan Kumar
- Biomedical Informatics Centre, National Institute for Research in Reproductive and Child Health, ICMR, Mumbai, Maharashtra, India
| | - Taruna Madan
- Department of Innate Immunity, National Institute for Research in Reproductive and Child Health, ICMR, Mumbai, India
| | - Mohamed H. Shamji
- Immunomodulation and Tolerance Group, Allergy and Clinical Immunology, Department of National Heart and Lung Institute and NIHR Biomedical Research Centre, Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom
| | - Roberta Bulla
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Daniel Mitchell
- WMS - Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Valarmathy Murugaiah
- Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Martin Mayora Neto
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent and Greenwich, United Kingdom
| | - Nigel Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, University of Kent and Greenwich, United Kingdom
| | - Susan Idicula-Thomas
- Biomedical Informatics Centre, National Institute for Research in Reproductive and Child Health, ICMR, Mumbai, Maharashtra, India
| | - Praveen M. Varghese
- Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
- School of Biosciences and Technology, Vellore Institute of Technology, Vellore, India
- *Correspondence: Praveen M. Varghese, ; Uday Kishore,
| | - Uday Kishore
- Biosciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
- Department of Veterinary Medicine, U.A.E. University, Al Ain, United Arab Emirates
- *Correspondence: Praveen M. Varghese, ; Uday Kishore,
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12
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Rouadi PW, Idriss SA, Bousquet J, Laidlaw TM, Azar CR, Al-Ahmad MS, Yañez A, Al-Nesf MAY, Nsouli TM, Bahna SL, Abou-Jaoude E, Zaitoun FH, Hadi UM, Hellings PW, Scadding GK, Smith PK, Morais-Almeida M, Maximiliano Gómez R, Gonzalez Diaz SN, Klimek L, Juvelekian GS, Riachy MA, Canonica GW, Peden D, Wong GW, Sublett J, Bernstein JA, Wang L, Tanno LK, Chikhladze M, Levin M, Chang YS, Martin BL, Caraballo L, Custovic A, Ortego-Martell JA, Lesslar OJ, Jensen-Jarolim E, Ebisawa M, Fiocchi A, Ansotegui IJ. WAO-ARIA consensus on chronic cough - Part III: Management strategies in primary and cough-specialty care. Updates in COVID-19. World Allergy Organ J 2022; 15:100649. [PMID: 35600836 PMCID: PMC9117692 DOI: 10.1016/j.waojou.2022.100649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/30/2022] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chronic cough management necessitates a clear integrated care pathway approach. Primary care physicians initially encounter the majority of chronic cough patients, yet their role in proper management can prove challenging due to limited access to advanced diagnostic testing. A multidisciplinary approach involving otolaryngologists and chest physicians, allergists, and gastroenterologists, among others, is central to the optimal diagnosis and treatment of conditions which underly or worsen cough. These include infectious and inflammatory, upper and lower airway pathologies, or gastro-esophageal reflux. Despite the wide armamentarium of ancillary testing conducted in cough multidisciplinary care, such management can improve cough but seldom resolves it completely. This can be due partly to the limited data on the role of tests (eg, spirometry, exhaled nitric oxide), as well as classical pharmacotherapy conducted in multidisciplinary specialties for chronic cough. Other important factors include presence of multiple concomitant cough trigger mechanisms and the central neuronal complexity of chronic cough. Subsequent management conducted by cough specialists aims at control of cough refractory to prior interventions and includes cough-specific behavioral counseling and pharmacotherapy with neuromodulators, among others. Preliminary data on the role of neuromodulators in a proof-of-concept manner are encouraging but lack strong evidence on efficacy and safety. Objectives The World Allergy Organization (WAO)/Allergic Rhinitis and its Impact on Asthma (ARIA) Joint Committee on Chronic Cough reviewed the recent literature on management of chronic cough in primary, multidisciplinary, and cough-specialty care. Knowledge gaps in diagnostic testing, classical and neuromodulator pharmacotherapy, in addition to behavioral therapy of chronic cough were also analyzed. Outcomes This third part of the WAO/ARIA consensus on chronic cough suggests a management algorithm of chronic cough in an integrated care pathway approach. Insights into the inherent limitations of multidisciplinary cough diagnostic testing, efficacy and safety of currently available antitussive pharmacotherapy, or the recently recognized behavioral therapy, can significantly improve the standards of care in patients with chronic cough.
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Affiliation(s)
- Philip W. Rouadi
- Department of Otolaryngology – Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
- Ear, Nose and Throat Department, Dar Al Shifa Hospital, Hawally, Kuwait
| | - Samar A. Idriss
- Department of Otolaryngology – Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Lyon, France
| | - Jean Bousquet
- Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany
- Macvia France, Montpellier France
- Université Montpellier, Montpellier, France
| | - Tanya M. Laidlaw
- Department of Medicine, Harvard Medical School, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital Boston, Massachusetts, USA
| | - Cecilio R. Azar
- Department of Gastroenterology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
- Department of Gastroenterology, Middle East Institute of Health (MEIH), Beirut, Lebanon
- Department of Gastroenterology, Clemenceau Medical Center (CMC), Beirut, Lebanon
| | - Mona S. Al-Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Anahi Yañez
- INAER - Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina
| | - Maryam Ali Y. Al-Nesf
- Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | | | - Sami L. Bahna
- Allergy & Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | | | - Fares H. Zaitoun
- Department of Allergy Otolaryngology, LAU-RIZK Medical Center, Beirut, Lebanon
| | - Usamah M. Hadi
- Clinical Professor Department of Otolaryngology Head and Neck Surgery, American University of Beirut, Lebanon
| | - Peter W. Hellings
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology, Leuven, Belgium
- University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium
- University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium
- Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands
| | | | - Peter K. Smith
- Clinical Medicine Griffith University, Southport Qld, 4215, Australia
| | | | | | - Sandra N. Gonzalez Diaz
- Universidad Autónoma de Nuevo León, Hospital Universitario and Facultad de Medicina, Monterrey, Nuevo León, Mexico
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Georges S. Juvelekian
- Department of Pulmonary, Critical Care and Sleep Medicine at Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Moussa A. Riachy
- Department of Pulmonary and Critical Care, Hôtel-Dieu de France university Hospital, Beirut, Lebanon
| | - Giorgio Walter Canonica
- Humanitas University & Personalized Medicine Asthma & Allergy Clinic-Humanitas Research Hospital-IRCCS-Milano Italy
| | - David Peden
- UNC Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics UNC School of Medicine, USA
| | - Gary W.K. Wong
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | - James Sublett
- Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, 9800 Shelbyville Rd, Louisville, KY, USA
| | - Jonathan A. Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, USA
| | - Lianglu Wang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
| | - Luciana K. Tanno
- Université Montpellier, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, Montpellier, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Manana Chikhladze
- Medical Faculty at Akaki Tsereteli State University, National Institute of Allergy, Asthma & Clinical Immunology, KuTaisi, Tskaltubo, Georgia
| | - Michael Levin
- Division of Paediatric Allergology, Department of Paediatrics, University of Cape Town, South Africa
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Bryan L. Martin
- Department of Otolaryngology, Division of Allergy & Immunology, The Ohio State University, Columbus, OH, USA
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena. Cartagena de Indias, Colombia
| | - Adnan Custovic
- National Heart and Lund Institute, Imperial College London, UK
| | | | | | - Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Austria
- The interuniversity Messerli Research Institute, Medical University Vienna and University of Veterinary Medicine, Vienna, Austria
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Alessandro Fiocchi
- Translational Pediatric Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Holy See
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
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14
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Da Silva Sena CR, de Queiroz Andrade E, de Gouveia Belinelo P, Percival E, Prangemeier B, O'Donoghue C, Terry S, Burke T, Gunning W, Murphy VE, Robinson PD, Sly PD, Gibson PG, Collison AM, Mattes J. Higher exhaled nitric oxide at 6 weeks of age is associated with less bronchiolitis and wheeze in the first 12 months of age. Thorax 2021; 77:1106-1112. [PMID: 34862324 DOI: 10.1136/thoraxjnl-2021-217299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Nitric oxide in exhaled air (eNO) is used as a marker of type 2 immune response-induced airway inflammation. We aimed to investigate the association between eNO and bronchiolitis incidence and respiratory symptoms in infancy, and its correlation with eosinophil protein X (EPX). METHODS We followed up infants at 6 weeks of age born to mothers with asthma in pregnancy and measured eNO during natural sleep using a rapid response chemiluminescense analyser (CLD88; EcoMedics), collecting at least 100 breaths, interpolated for an expiratory flow of 50 mL/s. EPX normalised to creatinine was measured in urine samples (uEPX/c). A standardised questionnaire was used to measure symptoms in first year of life. Associations were investigated using multiple linear regression and robust Poisson regression models. RESULTS eNO levels were obtained in 184 infants, of whom 125/184 (68%) had 12 months questionnaire data available and 51/184 (28%) had uEPX/c measured. Higher eNO was associated with less respiratory symptoms during the first 6 weeks of life (n=184, ß-coefficient: -0.49, 95% CI -0.95 to -0.04, p=0.035). eNO was negatively associated with uEPX/c (ß-coefficient: -0.004, 95% CI -0.008 to -0.001, p=0.021). Risk incidence of bronchiolitis, wheeze, cold or influenza illness and short-acting beta-agonist use significantly decreased by 18%-24% for every unit increase in eNO ppb. CONCLUSION Higher eNO levels at 6 weeks of age may be a surrogate for an altered immune response that is associated with less respiratory symptoms in the first year of life.
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Affiliation(s)
- Carla Rebeca Da Silva Sena
- Priority Research Centre GrowUpWell, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Ediane de Queiroz Andrade
- Priority Research Centre GrowUpWell, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Patricia de Gouveia Belinelo
- Priority Research Centre GrowUpWell, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Elizabeth Percival
- Priority Research Centre GrowUpWell, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Benjamin Prangemeier
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Christopher O'Donoghue
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Sandrine Terry
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Tanya Burke
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - William Gunning
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Vanessa E Murphy
- Priority Research Centre GrowUpWell, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Paul D Robinson
- Respiratory Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Peter D Sly
- Queensland Children's Medical Research Institute, University of Queensland, Herston, Queensland, Australia
| | - Peter G Gibson
- Priority Research Centre Healthy Lungs, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Adam M Collison
- Priority Research Centre GrowUpWell, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Joerg Mattes
- Priority Research Centre GrowUpWell, The University of Newcastle and Hunter Medical Research Institute, Newcastle, New South Wales, Australia .,Department of Paediatric Respiratory and Sleep Medicine, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
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15
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Li Q, Zhou Q, Li Y, Liu E, Fu Z, Luo J, Liu S, Liu F, Chen Y, Luo Z. The predictive role of small airway dysfunction and airway inflammation biomarkers for asthma in preschool and school-age children: a study protocol for a prospective cohort study. Transl Pediatr 2021; 10:2630-2638. [PMID: 34765487 PMCID: PMC8578752 DOI: 10.21037/tp-21-239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/06/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Preschool children are at a high risk of developing asthma. Asthma in preschool children could remit in most cases, but could persist into school age, adolescence, or even adulthood in some cases. However, it is difficult to predict which children with preschool asthma will develop into school-age asthma. We present a cohort study protocol to explore the predictive role of small airway dysfunction and airway inflammation biomarkers of asthma in preschool and school-age children. METHODS A prospective cohort study will be conducted with at least 205 children with preschool asthma. All patients will be recruited when they consult a pediatric pulmonologist at the Children's Hospital of Chongqing Medical University and will be followed up to 6 years of age. Initially, patients' demographic information, medical history, physical findings, and questionnaire information will be collected, and baseline small airway function and inflammation biomarkers will be detected. During the follow-up period, medical history, physical findings, and the questionnaire results will be collected every 3 months, and small airway function will be tested by impulse oscillometry (IOS) every 6 months. At the final visit, a definite diagnosis of school-age asthma will be made by a pediatric pulmonologist based on the criteria of the Global Initiative for Asthma 2020. DISCUSSION The study will be the first to be conducted in preschool children assessing whether small airway dysfunction combined with airway eosinophilic biomarkers and club cell secretory protein is associated with school-age asthma. This study may provide new promising predictors of persistent asthma from preschool to school age. TRIAL REGISTRATION The study has been registered at the Chinese Clinical Trial Registry (ChiCTR2000039583). Registered on November 1, 2020. Protocol version: version 1.0, August 16, 2021.
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Affiliation(s)
- Qinyuan Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Qi Zhou
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yuanyuan Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Enmei Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Zhou Fu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jian Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Sha Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Fangjun Liu
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Lanzhou University Institute of Health Data Science, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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16
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Annangi S, Nutalapati S, Sturgill J, Flenaugh E, Foreman M. Eosinophilia and fractional exhaled nitric oxide levels in chronic obstructive lung disease. Thorax 2021; 77:351-356. [PMID: 34417353 PMCID: PMC8938670 DOI: 10.1136/thoraxjnl-2020-214644] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/19/2021] [Indexed: 11/25/2022]
Abstract
Introduction COPD is a heterogeneous disorder with varied phenotypes. We aimed to determine the prevalence of asthma history, peripheral eosinophilia and elevated FeNO levels along with the diagnostic utility of peripheral eosinophilia in identifying airway eosinophilic inflammation. Methods National Health and Nutrition Examination Survey data were analysed for the study period 2007–2010. Subjects aged ≥40 years with postbronchodilator FEV1/FVC ratio <0.70 were included. Receiver operator curve analysis was performed for sensitivity analysis. A p value of <0.001 is considered statistically significant. Results A total of 3 110 617 weighted COPD cases were identified; predominantly male (64.4%) and non-Hispanic whites (86.1%). Among our COPD subjects, 14.6% had a history of doctor diagnosed asthma, highest among females and other race Americans. The overall prevalence of peripheral eosinophilia is 36%, 38.3% among COPD subjects with asthma history, and 35.6% among COPD without asthma history. The overall prevalence of elevated FeNO ≥25 ppb is 14.3%; 28.7% among COPD subjects with asthma history and 13.0% among COPD without asthma history. Discussion The prevalence of FeNO levels ≥25 ppb and peripheral eosinophilia was significantly higher among COPD subjects with asthma compared with COPD without asthma history. Not all COPD subjects with peripheral eosinophilia and elevated FeNO levels have a reported history of asthma. Our study supports clinically phenotyping COPD subjects with eosinophilic inflammation be independent of their asthma history and peripheral eosinophilia can be used as a surrogate marker in resource-limited settings.
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Affiliation(s)
- Srinadh Annangi
- Department of Pulmonary Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Snigdha Nutalapati
- Department of Hematology and Oncology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Jamie Sturgill
- Department of Pulmonary Critical Care and Sleep Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Eric Flenaugh
- Department of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Marilyn Foreman
- Department of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
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17
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Chen WH, Chang CM, Mutuku JK, Lam SS, Lee WJ. Aerosol deposition and airflow dynamics in healthy and asthmatic human airways during inhalation. JOURNAL OF HAZARDOUS MATERIALS 2021; 416:125856. [PMID: 34492805 DOI: 10.1016/j.jhazmat.2021.125856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 03/13/2021] [Accepted: 04/06/2021] [Indexed: 05/07/2023]
Abstract
Inhalation of aerosols such as pharmaceutical aerosols or virus aerosol uptake is of great concern to the human population. To elucidate the underlying aerosol dynamics, the deposition fractions (DFs) of aerosols in healthy and asthmatic human airways of generations 13-15 are predicted. The Navier-stokes equations governing the gaseous phase and the discrete phase model for particles' motion are solved using numerical methods. The main forces responsible for deposition are inertial impaction forces and complex secondary flow velocities. The curvatures and sinusoidal folds in the asthmatic geometry lead to the formation of complex secondary flows and hence higher DFs. The intensities of complex secondary flows are strongest at the generations affected by asthma. The DF in the healthy airways is 0%, and it ranges from 1.69% to 52.93% in the asthmatic ones. From this study, the effects of the pharmaceutical aerosol particle diameters in the treatment of asthma patients can be established, which is conducive to inhibiting the inflammation of asthma airways. Furthermore, with the recent development of COVID-19 which causes pneumonia, the predicted physics and effective simulation methods of bioaerosols delivery to asthma patients are vital to prevent the exacerbation of the chronic ailment and the epidemic.
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Affiliation(s)
- Wei-Hsin Chen
- Department of Aeronautics and Astronautics, National Cheng Kung University, Tainan 701, Taiwan; Research Center for Smart Sustainable Circular Economy, Tunghai University, Taichung 407, Taiwan; Department of Mechanical Engineering, National Chin-Yi University of Technology, Taichung 411, Taiwan.
| | - Che-Ming Chang
- Department of Aeronautics and Astronautics, National Cheng Kung University, Tainan 701, Taiwan; International Master Degree Program on Energy Engineering, National Cheng Kung University, Tainan 701, Taiwan
| | - Justus Kavita Mutuku
- Department of Environmental Engineering, National Cheng Kung University, Tainan 701, Taiwan; Center for Environmental Toxin and Emerging-Contaminant Research, Cheng Shiu University, Kaohsiung 833, Taiwan; Super micro mass research and technology center, Cheng Shiu University, Kaohsiung 833, Taiwan
| | - Su Shiung Lam
- Pyrolysis Technology Research Group, Higher Institution Centre of Excellence (HICoE), Institute of Tropical Aquaculture and Fisheries (AKUATROP), Universiti Malaysia Terengganu, Kuala Nerus 21030, Terengganu, Malaysia; Henan Province Engineering Research Center for Biomass Value-Added Products, Henan Agricultural University, Zhengzhou 450002, Henan, China
| | - Wen-Jhy Lee
- Department of Environmental Engineering, National Cheng Kung University, Tainan 701, Taiwan
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18
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Fujino N, Sugiura H. ACO (Asthma-COPD Overlap) Is Independent from COPD, a Case in Favor: A Systematic Review. Diagnostics (Basel) 2021; 11:859. [PMID: 34064650 PMCID: PMC8150952 DOI: 10.3390/diagnostics11050859] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 01/03/2023] Open
Abstract
Asthma and chronic obstructive pulmonary disease (COPD) are now recognized to be able to co-exist as asthma-COPD overlap (ACO). It is clinically relevant to evaluate whether patients with COPD concurrently have components of asthma in primary care. This is because: (i) ACO is a relatively common condition among asthma (over 40 years of age) or COPD irrespective of its diagnosis criteria; (ii) patients with ACO can have higher frequency of exacerbation and more rapid decline in lung function than those with asthma or COPD; and (iii) asthmatic features such as eosinophilic airway inflammation are promising indicators for prediction of inhaled corticosteroid-responsiveness in COPD. The aim of this review to evaluate diagnostic markers for ACO. We searched PubMed for articles related to ACO published until 2020. Articles associated with diagnostic biomarkers were included. We identified a total of 25 studies, some of which have revealed that a combination of biomarkers such as fractional exhaled nitric oxide and serum immunoglobulin E is useful to discern type 2 inflammation in the airways of COPD. Here, we review the current understanding of the clinical characteristics, biomarkers and molecular pathophysiology of ACO in the context of how ACO can be differentiated from COPD.
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Affiliation(s)
- Naoya Fujino
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan;
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朱 梦, 高 学, 朱 壮, 胡 晓, 刘 济, 周 慧. [The role of nasal nitric oxide in diagnosis and endotypes of chronic rhinosinusitis with nasal polyp]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:216-223. [PMID: 33794605 PMCID: PMC10128229 DOI: 10.13201/j.issn.2096-7993.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Indexed: 11/12/2022]
Abstract
Objective:To investigate the roles of nasal nitric oxide(nNO) in diagnosis and endotypes of CRSwNP. Methods:Eighty-two CRSwNP patients and thirty healthy volunteers were recruited for this study. The patients were classified into eosinophilic CRSwNP (Eos CRSwNP) and non-eosinophilic CRSwNP (non-Eos CRSwNP) endotypes by tissue eosinophil percentage. nNO levels were measured with an electrochemical sensor-based device. nNO levels and clinical factors were compared among the groups. Receiver-operating characteristic (ROC) curve and logistic regression analyses were performed to evaluate the predictive ability of the nNO for diagnosis and endotypes of CRSwNP. Results:Eos CRSwNP patients(143.9±106.2) ×10-9 had lower nNO levels than non-Eos CRSwNP[(228.3±109.2) ×10-9, P=0.000 9) and healthy subjects(366.5±88.0) ×10-9, P<0.000 1). Patients with atopy exhibited significantly higher levers of nNO compared with patients without atopy(P<0.05). For Eos CRSwNP diagnosis, nNO had the highest predictive value(AUC: 0.939; sensitivity: 76.74%; specificity: 96.67%; cut-off value: 231×10-9, P<0.001). Furthermore, nNO levels were associated with CRSwNP endotypes(odds ratio: 1.010; 95% confidence interval: 1.003%, 1.016%; P=0.002). When the nNO concentration was 158 ×10-9, we could discriminate Eos CRSwNP from non-Eos CRSwNP(AUC=0.710, sensitivity: 76.92%; specificity, 60.47%, P=0.001). After it was combinated by nNO, periphera blood eosinophil count(PEAC) and VAS score, the AUC was increased to 0.894(95%CI=0.807 to 0.951, P<0.000 1, sensitivity: 76.74%, specificity: 89.74%). Conclusion:nNO may has potential for non-invasive diagnosis and endotype of CRSwNP. nNO combined with PEAC and VAS score may be an ideal diagnostic tool for endotyps of Eos CRSwNP. However, the atopic status of the patients influenced the levels of nNO.
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Affiliation(s)
- 梦迪 朱
- 苏州大学附属第一医院耳鼻咽喉头颈外科(江苏苏州,215006)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - 学欢 高
- 复旦大学公共卫生学院Department of Environmental Health, School of Public Health, Fudan University
| | - 壮 朱
- 苏州大学附属第一医院骨科Department of Orthopaedics, the First Affiliated Hospital of Soochow University
| | - 晓清 胡
- 苏州大学附属第一医院耳鼻咽喉头颈外科(江苏苏州,215006)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - 济生 刘
- 苏州大学附属第一医院耳鼻咽喉头颈外科(江苏苏州,215006)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - 慧 周
- 苏州大学附属第一医院耳鼻咽喉头颈外科(江苏苏州,215006)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Soochow University, Suzhou, 215006, China
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Darif D, Hammi I, Kihel A, El Idrissi Saik I, Guessous F, Akarid K. The pro-inflammatory cytokines in COVID-19 pathogenesis: What goes wrong? Microb Pathog 2021; 153:104799. [PMID: 33609650 PMCID: PMC7889464 DOI: 10.1016/j.micpath.2021.104799] [Citation(s) in RCA: 168] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 02/06/2023]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, has emerged in China in December 2019 and rapidly spread to more than 196 countries worldwide. The physiopathology of human SARS-CoV-2 has not been completely understood, but its pathogenesis has been linked to a disproportionate response of the immune system. Just as described for SARS and MERS, an uncontrolled systemic inflammatory response, known as cytokine release syndrome (CRS) was observed in severe COVID-19 patients. It results from the release by immune and non-immune effector cells of substantial amounts of pro-inflammatory cytokines and appears to contribute to SARS-CoV-2 pulmonary inflammation and extensive lung damage. In addition, hyper-coagulation and thrombosis resulted from the important release of pro-inflammatory cytokines contribute to the lethality of subjects severely infected with SARS-CoV-2. It is therefore essential to have a deep understanding of the various cytokines involved in this exacerbated immune response, and that could be targeted by potential immunological treatments. The aim of this review was to gather the current knowledge about the role of pro-inflammatory cytokines, namely IL-1β, IL-6, IL-8, IL-17 and TNFα in SARS-CoV-2 CRS, the probable causes and clinical outcomes of this phenomenon in severe cases of COVID-19.
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Affiliation(s)
- Dounia Darif
- Molecular Genetics and Immunophysiopathology Research Team, Health and Environment Laboratory, Aïn Chock Faculty of Sciences, Hassan II University of Casablanca (UH2C), Morocco
| | - Ikram Hammi
- Molecular Genetics and Immunophysiopathology Research Team, Health and Environment Laboratory, Aïn Chock Faculty of Sciences, Hassan II University of Casablanca (UH2C), Morocco
| | - Ayyoub Kihel
- Molecular Genetics and Immunophysiopathology Research Team, Health and Environment Laboratory, Aïn Chock Faculty of Sciences, Hassan II University of Casablanca (UH2C), Morocco
| | - Imane El Idrissi Saik
- Immunopathology of Infectious and Systemic Diseases, Laboratory of Cellular and Molecular Pathology, Faculty of Medicine and Pharmacy, UH2C, Morocco
| | - Fadila Guessous
- Department of Biological Sciences, Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca, Morocco; Department of Microbiology, Immunology and Cancer Biology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Khadija Akarid
- Molecular Genetics and Immunophysiopathology Research Team, Health and Environment Laboratory, Aïn Chock Faculty of Sciences, Hassan II University of Casablanca (UH2C), Morocco.
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Jang YY, Ahn JY. Evaluation of Fractional Exhaled Nitric Oxide in Pediatric Asthma and Allergic Rhinitis. CHILDREN-BASEL 2020; 8:children8010003. [PMID: 33374635 PMCID: PMC7822451 DOI: 10.3390/children8010003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
Fractional exhaled nitric oxide (FeNO) is a non-invasive test for evaluating the degree of airway inflammation and for the diagnosis, evaluation, and treatment of asthma. We attempted to measure FeNO levels in Korean children with asthma and determine its cutoff value for diagnosing asthma. We enrolled 176 children and adolescents between the ages of 5 and 18 years, who visited for the evaluation of chronic cough, shortness of breath, and wheezing. Among them, 138 patients who underwent skin prick tests or inhalation Immuno CAP (UniCAP; Pharmacia, Uppsala, Sweden) tests for allergy testing together with a pulmonary function test were included. FeNO was measured using a NIOX MINO (Aerocrine AB, Solna, Sweden) instrument according to the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. There were 29 patients with asthma, 43 with rhinitis, and 38 with asthma and allergic rhinitis. In the asthma group, FeNO levels significantly correlated with total immunoglobulin E (r = 0.572, p < 0.001), but did not show significant correlation with pulmonary function test parameters (forced vital capacity—FVC, forced expiratory volume in one second—FEV1, FEV1/FVC) or PC20 (provocative concentration of methacholine causing a 20% fall in FEV1). The FeNO cutoff values obtained in the asthma and asthma rhinitis groups were 16.5 ppb and 18.5 ppb, respectively. Hence, we provide a FeNO cutoff value according to the presence or absence of rhinitis in pediatric patients with asthma.
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Affiliation(s)
- Yoon Young Jang
- Department of Pediatrics, School of Medicine, Daegu Catholic University Medical Center, Daegu 42472, Korea;
| | - Ji Young Ahn
- Department of Pediatrics, College of Medicine, Yeungnam University, Daegu 38541, Korea
- Correspondence: ; Tel.: +82-53-620-3536; Fax: +82-53-620-4459
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Zhu M, Gao X, Zhu Z, Hu X, Zhou H, Liu J. The roles of nasal nitric oxide in diagnosis and endotypes of chronic rhinosinusitis with nasal polyps. J Otolaryngol Head Neck Surg 2020; 49:68. [PMID: 32962755 PMCID: PMC7507626 DOI: 10.1186/s40463-020-00465-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/11/2020] [Indexed: 01/17/2023] Open
Abstract
Background Chronic rhinosinusitis with polyps (CRSwNP) is a global health concern. Nasal nitric oxide (nNO), a clinical biomarker, have been studied to assess the presence of airway mucosal inflammation. This study aimed to clarify the roles of nNO in diagnosis and endotypes of CRSwNP. Methods Eighty-two CRSwNP patients and thirty healthy volunteers were recruited for this study. The patients were classified into eosinophilic CRSwNP (Eos CRSwNP) and non⁃eosinophilic CRSwNP (Non-Eos CRSwNP) endotypes by tissue eosinophil percentage. nNO levels were measured with an electrochemical sensor-based device. nNO levels and clinical factors were compared among the groups. Receiver-operating characteristic (ROC) curve and logistic regression analyses were performed to evaluate the predictive ability of the nNO for diagnosis and endotypes of CRSwNP. Results Eos CRSwNP patients(143.9 ± 106.2, ppb) had lower nNO levels than Non-Eos CRSwNP(228.3 ± 109.2, ppb, p = 0.013) and healthy subjects(366.5 ± 88, ppb, p < 0.0001). Patients with atopy exhibited significantly higher levers of nNO compared with patients without atopy (p < 0.05). For Eos CRSwNP diagnosis, nNO had high predictive value for Eos CRSwNP (AUC: 0.939; sensitivity: 76.74%; specificity: 96.67%; cut-off value: 231 ppb, p < 0.001). Furthermore, nNO levels were associated with CRSwNP endotypes (odds ratio: 1.010; 95% confidence interval: 1.003, 1.016%; p = 0.002). When the nNO concentration was 158 ppb, we could discriminate Eos CRSwNP from Non-Eos CRSwNP (AUC = 0.710, sensitivity: 76.92%; specificity, 60.47%, P = 0.001). After it was combinated by nNO, peripheral blood eosinophil count (PEAC) and VAS score, the AUC was increased to 0.894 (95%CI = 0.807 to 0.951, p < 0.0001, sensitivity:76.74%, specificity: 89.74%). Conclusions nNO may have potential for non-invasive diagnosis and endotype of CRSwNP. nNO combined with PEAC and VAS score may be a good diagnostic tool for endotyps of Eos CRSwNP. However, the atopic status of the patients influenced the levels of nNO.
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Affiliation(s)
- Mengdi Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Shi'zi Road 188, Suzhou, 215006, China
| | - Xuehuan Gao
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Zhuang Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoqing Hu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Shi'zi Road 188, Suzhou, 215006, China
| | - Hui Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Shi'zi Road 188, Suzhou, 215006, China.
| | - Jisheng Liu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Soochow University, Shi'zi Road 188, Suzhou, 215006, China.
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Koren Y, Armoni Domany K, Gut G, Hadanny A, Benor S, Tavor O, Sivan Y. Respiratory effects of acute milk consumption among asthmatic and non-asthmatic children: a randomized controlled study. BMC Pediatr 2020; 20:433. [PMID: 32919454 PMCID: PMC7488715 DOI: 10.1186/s12887-020-02319-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A commonly held public belief is that cow's milk products increase mucus production and respiratory symptoms. Dietary milk elimination is often attempted despite lack of evidence. Our objective was to investigate whether a single exposure to cow's milk is associated with respiratory symptoms and changes in pulmonary functions in asthmatic and non-asthmatic children. METHODS We conducted a prospective double blind, placebo-controlled trial on non-asthmatic and asthmatic children aged 6-18 years evaluated at a pediatric pulmonology unit. The children were randomly challenged with cow's milk or soy milk substitute. Symptoms, spirometry, fractional-exhaled nitric-oxide (FeNO), and pulse oximetry findings were obtained at baseline and at 30, 60, 90, and 120 min following challenge. A two-way ANCOVA (with repeated measures when required) was used to compare the performances of all groups and subgroups over time. The outcome measures of each participant were compared to his/her own variables over time and in relation to his/her baseline values. In case of missing data points, missingness analysis was performed using Little's missing completely at random (MCAR) test. RESULTS Fifty non-asthmatic children (26 assigned to the cow's milk group and 24 to the soy substitute group), and 46 asthmatic children (22 in the cow's milk group and 24 in the soy substitute group) were enrolled. Age, gender, and body mass index Z-score were comparable between the two groups. No changes in symptoms, spirometry, FeNO, or oxygen saturation measurements were observed following challenge in any of the participants in both groups, at any time point compared to baseline. CONCLUSIONS A single exposure to cow's milk is not associated with symptoms, bronchial inflammation, or bronchial constriction in both non-asthmatic and asthmatic children. Our findings do not support the strict elimination of dairy products from a child's diet for the prevention of respiratory symptoms. TRIAL REGISTRATION This study was approved by the Tel Aviv Sourasky Medical Center Institutional Review Board and the Israeli Ministry of Health review board (Helsinki Committee, NIH #NCT02745899). Registered April 2016 https://clinicaltrials.gov/ct2/show/NCT02745899?cond=milk+asthma&rank=1 .
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Affiliation(s)
- Yael Koren
- Dana-Dwek Children's Hospital, Tel Aviv-Yafo, Israel
| | - Keren Armoni Domany
- Pediatric Pulmonary Unit, The Edith Wolfson Medical Center, Holon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Gut
- Pediatric Pulmonary Institute, Ruth Children's Hospital, Rambam Health, Care Campus, Haifa, Israel
| | - Amir Hadanny
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Shira Benor
- Dana-Dwek Children's Hospital, Tel Aviv-Yafo, Israel
| | - Oren Tavor
- Dana-Dwek Children's Hospital, Tel Aviv-Yafo, Israel
| | - Yakov Sivan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Pediatric Pulmonology, Safra Children Hospital, Sheba Medical Center, Tel Hashomer, Israel.
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Nguyen VN, Chavannes NH. Correlation between fractional exhaled nitric oxide and Asthma Control Test score and spirometry parameters in on-treatment-asthmatics in Ho Chi Minh City. J Thorac Dis 2020; 12:2197-2209. [PMID: 32642125 PMCID: PMC7330382 DOI: 10.21037/jtd.2020.04.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Although fractional exhaled nitric oxide (FeNO) is a reliable and easily applied marker of airway inflammation in asthma, the relationship between FeNO and indicators of asthma control [Asthma Control Test (ACT) score] and/or severity (spirometry parameters) remains unclear. This study aims to determine possible correlations between FeNO and ACT score; and between FeNO and spirometry parameters. Methods A cross-sectional study with convenience sampling was conducted among ambulatory patients in the Asthma & COPD clinic at the University Medical Center, Ho Chi Minh City from March 2016 to March 2017. Using measurement of FeNO, the ACT questionnaire and a spirometry test, correlations were determined between FeNO and the ACT score and spirometry parameters. Results Four hundred and ten asthmatic patients (mean age 42 years; 65% female) were included and analyzed; their mean time since onset of asthma was 9.5 years. All patients were treated following step 2 to 4 of GINA guidelines. Mean (SD) FeNO was 29.5 (24.4) parts per billion (ppb) and mean (SD) ACT score was 20.5 (40). A significant difference in FeNO values was found among the three groups with different asthma control levels categorized according to the ACT score (P=0.001) but was not found among the three groups with different asthma treatment levels (P=0.425). FeNO was significantly inversely correlated with the ACT score (Spearman’s r =−0.224, P<0.001) and with spirometry parameters indicate airway obstruction such as predicted FEV1, FEV1/FVC, predicted PEF and predicted FEF25–75% with Spearman’s r were −0.187; −0.143; −0.091 and −0.195, respectively (all P<0.05), whereas no correlation between FeNO and FVC—an indicator of airway restriction—was found. Conclusions In these asthmatic patients in Vietnam, an inverse correlation was found between FeNO and the ACT score and between FeNO and spirometry indicators of airway obstruction. Therefore, FeNO may be a useful tool in asthma management.
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Affiliation(s)
- Vinh Nhu Nguyen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department of Family Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.,Department of Respiratory Functional Exploration, University Medical Center, Ho Chi Minh City, Vietnam
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Dinh-Thi-Dieu H, Vo-Thi-Kim A, Tran-Van H, Tang-Thi-Thao T, Duong-Quy S. Study of the beneficial role of exhaled nitric oxide in combination with GINA guidelines for titration of inhaled corticosteroids in children with asthma. J Breath Res 2020; 14:026014. [PMID: 31905348 DOI: 10.1088/1752-7163/ab6809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The use of FENO in association with current guidelines in the treatment of asthma has not been studied thoroughly. This study aimed to evaluate the beneficial role of FENO in combination with GINA (Global Initiative for Asthma) guidelines for titration of inhaled corticosteroids (ICS) in asthmatic children. METHODS It was a prospective and descriptive study. Uncontrolled asthmatic children were randomized to two groups: group 1 (followed GINA guidelines) or group 2 (followed GINA guidelines + FENO modification for ICS titration). The two groups were followed-up for 12 months. RESULTS The mean age of the patients in the study was 10 ± 4 years for group 1 (n = 116) and 11 ± 5 years for group 2 (n = 108). There were 87.9% patients in group 1 and 82.4% in group 2 that had a familial allergic history. There were 58.6% of moderate asthma and 41.4% of severe asthma in group 1, versus 56.4% and 43.6% in group 2, respectively. The percentage of moderate and severe asthma was also significantly modified after 6th and 12th month versus at inclusion (43.1% and 35.3% versus 58.6%, P < 0.01 and P < 0.005; 23.2% and 12.9% versus 41.4%, P < 0.005 and P < 0.001, respectively). The total daily dose of ICS in group 2 at 12th months was significantly lower than that in group 1 (3515 ± 1175 versus 4785 ± 1235 mcg; P < 0.005). The daily cost of ICS treatment in group 2 was also lower than that of group 1 (18 ± 4 versus 27 ± 3 USD; P < 0.05). CONCLUSION The use of FENO in combination with GINA guidelines for ICS titration is useful in reducing the daily ICS dose and treatment cost.
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Lee DH, Kwon JW, Kim HY, Seo JH, Kim HB, Lee SY, Jang GC, Song DJ, Kim WK, Jung YH, Hong SJ, Shim JY. Asthma predictive index as a useful diagnostic tool in preschool children: a cross-sectional study in Korea. Clin Exp Pediatr 2020; 63:104-109. [PMID: 32024332 PMCID: PMC7073380 DOI: 10.3345/kjp.2019.00640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 11/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND It is challenging to diagnose asthma in preschool children. The asthma predictive index (API) has been used to predict asthma and decide whether to initiate treatment in preschool children. PURPOSE This study aimed to investigate the association between questionnaire-based current asthma with API, pulmonary function, airway hyperreactivity (AHR), fractional expiratory nitric oxide (FeNO), and atopic sensitization in preschool children. METHODS We performed a population-based cross-sectional study in 916 preschool children aged 4-6 years. We defined current asthma as the presence of both physician-diagnosed asthma and at least one wheezing episode within the previous 12 months using a modified International Study of Asthma and Allergies in Childhood questionnaire. Clinical and laboratory parameters were compared between groups according to the presence of current asthma. RESULTS The prevalence of current asthma was 3.9% in the study population. Children with current asthma showed a higher rate of positive bronchodilator response and loose and stringent API scores than children without current asthma. The stringent API was associated with current asthma with 72.2% sensitivity and 82.0% specificity. The diagnostic accuracy of the stringent API for current asthma was 0.771. However, no intergroup differences in spirometry results, methacholine provocation test results, FeNO level, or atopic sensitization rate were observed. CONCLUSION The questionnaire-based diagnosis of current asthma is associated with API, but not with spirometry, AHR, FeNO, or atopic sensitization in preschool children.
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Affiliation(s)
- Dong Hyeon Lee
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Sungnam, Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo-Bin Kim
- Department of Pediatrics, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gwang-Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Dae-Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul, Korea
| | - Young-Ho Jung
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Research Center for Standardization of Allergic Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Xiong Y, Li B, Zhang Y, Shi F, Qiu C, Wang L, Wang J, Le Y, Du Y, Yao C, Li S, Liu W, Chen D, Feng M. Expression of herpesvirus entry mediator gene as a potential biomarker for disease severity in patients with persistent asthma. J Asthma 2020; 58:717-724. [PMID: 32045312 DOI: 10.1080/02770903.2020.1729382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Herpes virus entry mediator (HVEM) is a costimulatory molecule, and has been proved to play an important role in airway inflammatory and remodeling processes of asthma. We aimed to investigate the expression of HVEM gene in patients with asthma as a means of assessing disease severity.Methods: This study was carried out on 59 subjects, 16 patients with mild persistent asthma, 11 patients with moderate persistent asthma, 13 patients with severe persistent asthma, and 19 age and gender matched healthy controls. The HVEM mRNA expressions of all subjects were determined by real time PCR. Correlations between HVEM mRNA expression and fractional exhaled nitric oxide (FeNO), pulmonary function test values, total blood white cell count and differential, total immunoglobulin E (IgE) level, and Asthma Control Test (ACT) score were analyzed, respectively. The discrimination abilities of HVEM mRNA between different groups were tested using receiver operating characteristics (ROC) curve analyses.Results: This study showed the expressions of HVEM mRNA were significantly higher in the patients with severe and moderate persistent asthma than in patients with mild persistent asthma and healthy subjects (2.97 ± 1.23 vs. 1.17 ± 0.42 vs. 0.62 ± 0.38 vs. 0.46 ± 0.18/NAPDH, p < 0.001), but there was no significant difference between patients with mild persistent asthma and health controls (0.62 ± 0.38 vs. 0.46 ± 0.18/NAPDH, p = 0.557). HVEM mRNA expression at cut off point [1.01/NAPDH, area under the ROC curve (AUC) = 0.99] is sufficient to discriminate severe patients from mild-to-moderate patients, and at cut off point (0.93/NAPDH, AUC = 0.91) for discrimination of moderate-to-severe patients from mild ones, while at cut off point (0.76/NAPDH, AUC = 0.75) for discrimination of asthmatic patients from controls. Furthermore, HVEM mRNA expression was positively correlated with FeNO level (r = 0.524, p = 0.015), and total lymphocyte count (r = 0.426, p = 0.017) in patients with persistent asthma.Conclusions: HVEM gene expressions can be used as a potential biomarker for evaluating the severity of patients with persistent asthma.
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Affiliation(s)
- Yi Xiong
- Shenzhen Key Laboratory for Neuronal Structural Biology, Biomedical Research Institute, Shenzhen Peking University - The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
| | - Binbin Li
- Emergency Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
| | - Yidan Zhang
- Shenzhen Key Laboratory for Neuronal Structural Biology, Biomedical Research Institute, Shenzhen Peking University - The Hong Kong University of Science and Technology Medical Center, Shenzhen, China
| | - Fei Shi
- Emergency Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
| | - Chen Qiu
- Respiratory Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
| | - Lingwei Wang
- Respiratory Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
| | - Jin Wang
- Emergency Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
| | - Ying Le
- Respiratory Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
| | - Yujie Du
- Respiratory Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
| | - Can Yao
- Respiratory Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
| | - Sinian Li
- Respiratory Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
| | - Wenwen Liu
- Emergency Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
| | - Dandan Chen
- Respiratory Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
| | - Mengjie Feng
- Respiratory Department, Shenzhen Institute of Respiratory Diseases, Jinan University, The Second Clinical College, Shenzhen, China
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Turner S, Cotton SC, Emele CD, Thomas R, Fielding S, Gaillard EA, de Jongste JC, Morgan H, Neilson AR, Norrie J, Pijnenburg M, Price D, Thomas M. Reducing Asthma Attacks in Children using Exhaled Nitric Oxide as a biomarker to inform treatment strategy: a randomised trial (RAACENO). Trials 2019; 20:573. [PMID: 31585544 PMCID: PMC6778366 DOI: 10.1186/s13063-019-3500-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/05/2019] [Indexed: 11/26/2022] Open
Abstract
Background Childhood asthma is a common condition. Currently there is no validated objective test which can be used to guide asthma treatment in children. This study tests the hypothesis that the addition of fractional exhaled nitric oxide (FENO) monitoring in addition to standard care reduces the number of exacerbations (or attacks) in children with asthma. Methods This is a multi-centre, randomised controlled study. Children will be included of age 6–16 years who have a diagnosis of asthma, currently use inhaled corticosteroids (ICSs) and have had an exacerbation in the previous 12 months. Exclusion criteria include being unable to provide FENO measurement at baseline assessment, having another chronic respiratory condition and being currently treated with maintenance oral steroids. Participants will be recruited in both primary and secondary care settings and will be randomised to either receive asthma treatment guided by FENO plus symptoms (FENO group) or asthma treatment guided by symptoms only (standard care group). Within the FENO group, different treatment decisions will be made dependent on changes in FENO. Participants will attend assessments 3, 6, 9 and 12 months post randomisation. The primary outcome is asthma exacerbation requiring prescription and/or use of an oral corticosteroid over 12 months as recorded by the participant/parent or in general practitioner records. Secondary outcomes include time to first attack, number of attacks, asthma control score and quality of life. Adherence to ICS treatment is objectively measured by an electronic logging device. Participants are invited to participate in a “phenotyping” assessment where skin prick reactivity and bronchodilator response are determined and a saliva sample is collected for DNA extraction. Qualitative interviews will be held with participants and research nurses. A health economic evaluation will take place. Discussion This study will evaluate whether FENO can provide an objective index to guide and stratify asthma treatment in children. Trial registration ISRCTN, ISRCTN67875351. Registered on 12 April 2017. Prospectively registered.
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Affiliation(s)
- S Turner
- Child Health, University of Aberdeen, Aberdeen, UK.
| | - S C Cotton
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - C D Emele
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - R Thomas
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - S Fielding
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - E A Gaillard
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - J C de Jongste
- Department of Paediatric Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - H Morgan
- Postgraduate Education Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - A R Neilson
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - J Norrie
- Centre for Healthcare Randomised Trials, University of Aberdeen, Aberdeen, UK
| | - M Pijnenburg
- Department of Paediatric Respiratory Medicine and Allergology, Erasmus MC - Sophia Children's Hospital, Rotterdam, Netherlands
| | - D Price
- Observational and Pragmatic Research Institute Pte Ltd, Singapore, Singapore.,Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
| | - M Thomas
- Primary Care and Population Sciences, University of Southampton, Southampton, UK.,NIHR Southampton Respiratory Biomedical Research Unit, Southampton, UK
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Abstract
Objective: HIV disrupts host defense mechanisms and maintains chronic inflammation in the lung. Nitric oxide is a marker of lung inflammation and can be measured in the exhaled air. We investigated the relationship between exhaled nitric oxide (eNO), HIV status and airway abnormalities in perinatally HIV-infected children aged 6–19 years. Design: A cross-sectional study. Methods: HIV-infected individuals on antiretroviral therapy and HIV-uninfected children with no active tuberculosis (TB) or acute respiratory tract infection were recruited from a public hospital in Harare, Zimbabwe. Clinical history was collected and eNO testing and spirometry was performed. The association between eNO and explanatory variables (HIV, FEV1 z-score, CD4+ cell count, viral load, history of TB) was investigated using linear regression analysis adjusted for age, sex and time of eNO testing. Results: In total, 222 HIV-infected and 97 HIV-uninfected participants were included. Among HIV-infected participants, 57 (25.7%) had a history of past TB; 56 (25.2%) had airway obstruction, but no prior TB. HIV status was associated with lower eNO level [mean ratio 0.79 (95% confidence interval, 95% CI 0.65–0.97), P = 0.03]. Within the HIV-infected group, history of past TB was associated with lower eNO levels after controlling for age, sex and time of eNO testing [0.79 (95% CI 0.67–0.94), P = 0.007]. Conclusion: HIV infection and history of TB were associated with lower eNO levels. eNO levels may be a marker of HIV and TB-induced alteration in pulmonary physiology; further studies focused on potential causes for lower eNO levels in HIV and TB are warranted.
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30
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Cardenas A, Sordillo JE, Rifas-Shiman SL, Chung W, Liang L, Coull BA, Hivert MF, Lai PS, Forno E, Celedón JC, Litonjua AA, Brennan KJ, DeMeo DL, Baccarelli AA, Oken E, Gold DR. The nasal methylome as a biomarker of asthma and airway inflammation in children. Nat Commun 2019; 10:3095. [PMID: 31300640 PMCID: PMC6625976 DOI: 10.1038/s41467-019-11058-3] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 06/19/2019] [Indexed: 12/16/2022] Open
Abstract
The nasal cellular epigenome may serve as biomarker of airway disease and environmental response. Here we collect nasal swabs from the anterior nares of 547 children (mean-age 12.9 y), and measure DNA methylation (DNAm) with the Infinium MethylationEPIC BeadChip. We perform nasal Epigenome-Wide Association analyses (EWAS) of current asthma, allergen sensitization, allergic rhinitis, fractional exhaled nitric oxide (FeNO) and lung function. We find multiple differentially methylated CpGs (FDR < 0.05) and Regions (DMRs; ≥ 5-CpGs and FDR < 0.05) for asthma (285-CpGs), FeNO (8,372-CpGs; 191-DMRs), total IgE (3-CpGs; 3-DMRs), environment IgE (17-CpGs; 4-DMRs), allergic asthma (1,235-CpGs; 7-DMRs) and bronchodilator response (130-CpGs). Discovered DMRs annotated to genes implicated in allergic asthma, Th2 activation and eosinophilia (EPX, IL4, IL13) and genes previously associated with asthma and IgE in EWAS of blood (ACOT7, SLC25A25). Asthma, IgE and FeNO were associated with nasal epigenetic age acceleration. The nasal epigenome is a sensitive biomarker of asthma, allergy and airway inflammation. Epigenetic differences in nasal epithelium have been proposed as a biomarker for lower airway disease and asthma. Here, in epigenome-wide association studies for asthma and other airway traits using nasal swabs, the authors identify differentially methylated CpGs that highlight genes involved in TH2 response.
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Affiliation(s)
- Andres Cardenas
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA, 94720, USA. .,Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA.
| | - Joanne E Sordillo
- Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
| | - Wonil Chung
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Liming Liang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Marie-France Hivert
- Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA.,Diabetes Unit, Massachusetts General Hospital, Boston, 02114, MA, USA
| | - Peggy S Lai
- Massachusetts General Hospital, Pulmonary/Critical Care, Boston, MA, 02114, USA
| | - Erick Forno
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA
| | - Juan C Celedón
- Division of Pediatric Pulmonary Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15224, USA
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Kasey J Brennan
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Dawn L DeMeo
- Department of Medicine, Brigham and Women's Hospital, Channing Division of Network Medicine, Harvard Medical School, Boston, MA, 02115, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Emily Oken
- Department of Population Medicine, Division of Chronic Disease Research Across the Lifecourse, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, 02215, USA
| | - Diane R Gold
- Department of Medicine, Brigham and Women's Hospital, Channing Division of Network Medicine, Harvard Medical School, Boston, MA, 02115, USA.,Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA
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Stefanidis C, Martineau AR, Nwokoro C, Griffiths CJ, Bush A. Vitamin D for secondary prevention of acute wheeze attacks in preschool and school-age children. Thorax 2019; 74:977-985. [PMID: 31278171 DOI: 10.1136/thoraxjnl-2019-213278] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/13/2019] [Accepted: 06/01/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Vitamin D is best known for its role in bone health; however, the discovery of the vitamin D receptor and the expression of the gene encoding the vitamin D 1α-hydroxylase (CYP27B1) enzyme in a wide variety of tissues including immune cells and respiratory epithelium has led to the discovery of potential roles for vitamin D in the prevention of acute wheeze. METHODS We review here the literature concerning the relationships between circulating 25-hydroxyvitamin D (25(OH)D) concentration and secondary prevention of acute wheeze attacks in preschool and school-age children. RESULTS Epidemiological data suggest that vitamin D insufficiency (25(OH)D <75 nmol/L) is highly prevalent in preschool and school-age children with wheeze. Preschool age children with a history of wheeze attacks and circulating 25(OH)D <75 nmol/L are at increased risk and frequency of future acute wheeze. However, no consistent association between low vitamin D status and risk of acute wheeze is reported in school-age children. Seven randomised controlled trials (RCTs) with relatively small sample sizes (30-430) and variable quality showed inconsistent results regarding the effect of oral vitamin D supplementation during childhood on the risk of asthma attacks, asthma symptom control, inhaled corticosteroid requirements, spirometry and unscheduled healthcare attendances for wheeze. A RCT showed that vitamin D supplementation had no effect on the frequency of unplanned healthcare attendances due to acute wheeze in 22 preschool children. DISCUSSION An evidence-based recommendation for the use of vitamin D as a preventive therapy for wheeze attacks cannot be made until results of further trials are available. The assessment of circulating 25(OH)D concentration and the optimisation of vitamin D status to prevent acute respiratory tract infections, and to maintain skeletal and general health in preschool and school-age children with acute wheeze is worthwhile in its own right, but whether this will reduce the risk of acute wheeze attacks is unclear.
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Affiliation(s)
- Christos Stefanidis
- Asthma UK Centre for Applied Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK .,Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Adrian R Martineau
- Asthma UK Centre for Applied Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chinedu Nwokoro
- Asthma UK Centre for Applied Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Christopher J Griffiths
- Asthma UK Centre for Applied Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrew Bush
- Asthma UK Centre for Applied Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Royal Brompton Hospital, Biomedical Research Unit at the Royal Brompton & Harefield NHS Foundation Trust, Imperial College London, London, UK
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32
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Ahovuo-Saloranta A, Csonka P, Lehtimäki L. Basic characteristics and clinical value of FeNO in smoking asthmatics-a systematic review. J Breath Res 2019; 13:034003. [PMID: 30861509 DOI: 10.1088/1752-7163/ab0ece] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fractional exhaled nitric oxide (FeNO) reflects eosinophilic airway inflammation and it can be used to diagnose and phenotype asthma and predict treatment responses. However, smoking decreases FeNO and it is not clear if FeNO has clinical value in smoking subjects with asthma. We conducted a systematic review focusing on four basic characteristics and five clinical questions on using FeNO in smokers with asthma. At least two authors independently screened search results, extracted data and assessed the quality of the included studies. Data were synthesised mainly by qualitative methods. Twenty-two studies were included. FeNO is lower in smoking than in non-smoking asthmatics, but importantly FeNO is higher in untreated smoking asthmatics than in healthy smokers. Information was incomplete but there is some indication that FeNO might be useful in detecting eosinophilic airway inflammation and in diagnosing asthma in smoking subjects. There was no data available to four of the five clinical questions. In conclusion, at the moment there is insufficient data to give specific guidelines on using FeNO in smoking subjects, but although smoking decreases FeNO it does not seem to make FeNO measurement redundant. FeNO is also associated with asthma in smokers and current results encourage conducting clinical trials on FeNO in smokers with asthma.
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Chang DV, Teper A, Balinotti J, Castro Simonelli C, Garcia-Bournissen F, Kofman C. Exhaled nitric oxide predicts loss of asthma control in children after inhaled corticosteroids withdrawal. Pediatr Pulmonol 2019; 54:537-543. [PMID: 30688035 DOI: 10.1002/ppul.24268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 01/02/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Exhaled nitric oxide (eNO) has been proposed for monitoring airway inflammation, diagnosis, and prediction of steroid responsiveness in asthma. However, its utility after elective suspension of asthma medication is still unclear. We aimed to determine the association between eNO values and the subsequent loss of asthma control (LAC) in asymptomatic asthmatic children after inhaled corticosteroids (ICS) withdrawal. METHODS We conducted a prospective observational cohort study. Forty-two children (23 boys), mean age 11 years, with clinically controlled asthma, according to GINA guidelines, and receiving low-dose of ICS (budesonide 200 μg/day or equivalent) were included immediately after the withdrawal of ICS. eNO, Asthma Control Test (ACT) and spirometry were monthly assessed, during 54 weeks or until the presence of at least one of the following criteria of LAC: 1) asthma exacerbation, 2) obstructive spirometric pattern, 3) ACT ≤ 19. RESULTS eNO baseline geometric mean (eNOb ), measured 4 weeks after discontinuation of ICS, was 23.7 ppb (SD: 1.16). An eNOb cutoff point of 21.8 ppb was determined to better discriminate between high and low eNO groups. Twenty-five subjects (71.4%) had LAC. High eNOb was associated to LAC (OR: 9.01; 95CI: 1.10-74.26). In addition, LAC occurred earlier in high eNOb than in low eNOb patients (8 vs 28 weeks, respectively; P = 0.017). CONCLUSIONS Our findings suggest that eNO predicts loss of asthma control and may contribute for clinical follow up decisions during childhood asthma after ICS withdrawal.
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Affiliation(s)
- Daniel V Chang
- Centro Respiratorio Dr. Alberto Álvarez, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Alejandro Teper
- Centro Respiratorio Dr. Alberto Álvarez, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Juan Balinotti
- Centro Respiratorio Dr. Alberto Álvarez, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina.,Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina
| | | | | | - Carlos Kofman
- Centro Respiratorio Dr. Alberto Álvarez, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
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Lo R, McGhee S. Is Dupilumab Effective in Treating Uncontrolled Moderate-to-Severe Asthma? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2019; 7:1705-1706. [PMID: 36443998 DOI: 10.1016/j.jaip.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/07/2019] [Accepted: 01/10/2019] [Indexed: 06/16/2023]
Affiliation(s)
- Rachelle Lo
- Division of Allergy, Immunology, and Rheumatology, Stanford University School of Medicine, Stanford, Calif.
| | - Sean McGhee
- Division of Allergy, Immunology, and Rheumatology, Stanford University School of Medicine, Stanford, Calif
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Reduced nasal nitric oxide levels in patients with eosinophilic chronic rhinosinusitis. Allergol Int 2019; 68:225-232. [PMID: 30348485 DOI: 10.1016/j.alit.2018.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/30/2018] [Accepted: 09/14/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In Eosinophilic chronic rhinosinusitis (ECRS), it is difficult to estimate the refractoriness and recurrence risk for each patient. Fraction of exhaled nitric oxide (FeNO) is known as a biomarker of eosinophilic inflammation in lower airway. It has been reported that nasal NO has some crucial functions in the upper and lower airways. However, in upper airway, paranasal sinuses, the usefulness of NO measurement remains controversial. The purpose of this study is to identify the usefulness of nasal NO measurement in ECRS and the involvement of nasal NO in the pathogenesis of ECRS. METHODS We compared the nasal NO levels of ECRS, non-ECRS, and normal control groups. Correlation between nasal NO levels and clinical findings were observed. Then, we compared nasal NO levels before and after endoscopic sinus surgery (ESS). We also examine whether nasal NO levels might discriminate ECRS by the receiver operating characteristic (ROC) curve analysis. RESULTS Nasal NO levels were significantly decreased in ECRS compared to the other two groups. Moreover, nasal NO levels in ECRS significantly and negatively correlated with eosinophil levels and CT score. However, they did not correlate with the nasal polyp score. Nasal NO levels were not upregulated soon after opening the sinus ostium by ESS. The ROC curves for nasal NO levels were used to discriminate all CRS patients and ECRS patients from normal controls. CONCLUSIONS Nasal NO may be useful as a marker of ECRS severity and low nasal NO levels in ECRS may contribute to its pathogenesis.
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Zhou J, Zhao X, Zhang X, Yu X, Wang Y, Jiang W, Huang L, Hao C, Zhang L. Values of fractional exhaled nitric oxide for cough-variant asthma in children with chronic cough. J Thorac Dis 2018; 10:6616-6623. [PMID: 30746207 PMCID: PMC6344719 DOI: 10.21037/jtd.2018.11.137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 11/09/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic cough is a common symptom in children. We wished to explore the value of fractional exhaled nitric oxide (FeNO) for cough-variant asthma (CVA) in children with chronic cough. METHODS This prospective cohort study was conducted in the Children's Hospital of Soochow University from January 2012 to December 2014. Children aged 6-14 years with a cough of duration >4 weeks were enrolled. They underwent FeNO measurement, sputum cytology and pulmonary function tests. RESULTS A total of 115 patients and 25 healthy controls were evaluated. For the diagnosis of CVA, the optimal FeNO cutoff value was 25 ppb with a sensitivity of 84.0%, specificity of 97.1%, positive predictive value of 97.5%, and negative predictive of being 81.4%. The FeNO level had a significant correlation with eosinophil count in sputum (P<0.05). FeNO level in CVA was decreased significantly after treatment (P=0.001). CONCLUSIONS In children, FeNO measurement might be an excellent method for diagnosing CVA with high sensitivity and specificity.
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Affiliation(s)
- Jing Zhou
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Xianhong Zhao
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Xu Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
| | - Xingmei Yu
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Yuqing Wang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Wujun Jiang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Li Huang
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Chuangli Hao
- Department of Respiratory Medicine, Children’s Hospital of Soochow University, Suzhou 215003, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China
- Department of Allergy, Beijing Tongren Hospital, Capital Medical University, Beijing 100000, China
- Beijing Key Laboratory of Nasal Diseases, Beijing Institute of Otolaryngology, Beijing 100005, China
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37
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Hoyte FCL, Gross LM, Katial RK. Exhaled Nitric Oxide: An Update. Immunol Allergy Clin North Am 2018; 38:573-585. [PMID: 30342580 DOI: 10.1016/j.iac.2018.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Fractional concentration of exhaled nitric oxide (FENO) is a biomarker used to identify allergic airway inflammation. Because it is noninvasive and easy to obtain, its utility has been studied in the diagnosis and management of several respiratory diseases. Much of the research has been done in asthma, and many studies support the use of FENO in aiding diagnosing asthma, predicting steroid responsiveness, and preventing exacerbations by guiding medication dosage and assessing adherence.
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Affiliation(s)
- Flavia C L Hoyte
- Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA.
| | - Lara M Gross
- Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA; Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado, 13001 E 17th Place, Aurora, CO 80045, USA
| | - Rohit K Katial
- Division of Allergy and Immunology, National Jewish Health, 1400 Jackson Street, Denver, CO 80206, USA
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Lu Z, Huang W, Wang L, Xu N, Ding Q, Cao C. Exhaled nitric oxide in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Int J Chron Obstruct Pulmon Dis 2018; 13:2695-2705. [PMID: 30214187 PMCID: PMC6124452 DOI: 10.2147/copd.s165780] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Fractional exhaled nitric oxide (FENO) is a useful and noninvasive biomarker for eosinophilic airway inflammation, particularly in asthma. However, its utility in chronic obstructive pulmonary disease (COPD) remains controversial. In this study, we performed a systematic review and meta-analysis to evaluate FENO levels in COPD. Methods A search of PubMed, Embase, Cochrane Library, and clinical trial registry was conducted from inception to January 2018. Studies were included if they reported FENO levels in patients with COPD and healthy controls. We then extracted relevant information and analyzed data. Standard mean difference (SMD) with 95% confidence interval (CI) was applied in this meta-analysis. Results A total of 2,073 studies were reviewed for eligibility, with 24 studies pooled for analysis. The FENO levels in patients with COPD were elevated mildly compared with healthy controls (SMD 1.28, 95% CI 0.60-1.96). A similar result was also observed in stable COPD, with an SMD of 1.21 (95% CI 0.47-1.96). On the other hand, we found no association between FENO levels and exacerbated COPD. Additionally, for patients with COPD, ex-smokers had higher levels of FENO than current smokers (SMD 2.05, 95% CI 1.13-2.97). Conclusion Our studies demonstrated a mild elevation of FENO in COPD, and the association between exacerbated COPD and FENO levels needs to be further explored. The potential mechanism is still unknown and conflicting.
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Affiliation(s)
- Zhiyu Lu
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, People’s Republic of China, ,Ningbo University School of Medicine, Ningbo, People’s Republic of China
| | - Weina Huang
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, People’s Republic of China,
| | - Linfeng Wang
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, People’s Republic of China,
| | - Ning Xu
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, People’s Republic of China,
| | - Qunli Ding
- Department of Respiratory Medicine, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, People’s Republic of China, ,Qunli Ding, Department of Respiratory Medicine, The Affiliated Hospital of Medical School of Ningbo University, 247 Renmin Road, Ningbo, Zhejiang 315020, People’s Republic of China, Tel/fax +86 574 8703 5778, Email
| | - Chao Cao
- Department of Respiratory Medicine, Ningbo First Hospital, Ningbo, People’s Republic of China, ,Correspondence: Chao Cao, Department of Respiratory Medicine, Ningbo First Hospital, 59 Liuting Road, Ningbo, Zhejiang 315010, People’s Republic of China, Tel/fax +86 574 8708 9878, Email
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Kwon JW, Park HW, Kim WJ, Kim MG, Lee SJ. Exposure to volatile organic compounds and airway inflammation. Environ Health 2018; 17:65. [PMID: 30086760 PMCID: PMC6081941 DOI: 10.1186/s12940-018-0410-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/26/2018] [Indexed: 05/20/2023]
Abstract
BACKGROUND Exposure to low levels of volatile organic compounds (VOCs) in ordinary life is suspected to be related to oxidative stress and decreased lung function. This study evaluated whether exposure to ambient VOCs in indoor air affects airway inflammation. METHODS Thirty-four subjects from the hospital that had moved to a new building were enrolled. Symptoms of sick building syndrome, pulmonary function tests, and fractional exhaled nitric oxide (FeNO) were evaluated, and random urine samples were collected 1 week before and after the move. Urine samples were analyzed for VOC metabolites, oxidative stress biomarkers, and urinary leukotriene E4 (uLTE4) levels. RESULTS The level of indoor VOCs in the new building was higher than that in the old building. Symptoms of eye dryness and eye irritation, as well as the level of a xylene metabolite (o-methylhippuric acid) increased after moving into the new building (p = 0.012, p = 0.008, and p < 0.0001, respectively). For the inflammatory markers, FeNO decreased (p = 0.012 and p = 0.04, respectively) and the uLTE4 level increased (p = 0.005) after the move. CONCLUSION Exposure to a higher level of VOCs in everyday life could affect airway inflammation.
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Affiliation(s)
- Jae-Woo Kwon
- Department of Allergy and Clinical Immunology, Kangwon National University Hospital, Chuncheon, South Korea.
- Department of Internal Medicine, Kangwon National University College of Medicine, Baengnyeong-ro 256, 200-722 Chuncheon-Si, Gangwon-Do, Chuncheon, South Korea.
- Environmental Health Center, Kangwon National University Hospital, Chuncheon, South Korea.
| | - Hee-Won Park
- Department of Rehabilitation Medicine, Kangwon National University College of Medicine, Chuncheon, South Korea
| | - Woo Jin Kim
- Department of Internal Medicine, Kangwon National University College of Medicine, Baengnyeong-ro 256, 200-722 Chuncheon-Si, Gangwon-Do, Chuncheon, South Korea
- Environmental Health Center, Kangwon National University Hospital, Chuncheon, South Korea
| | - Man-Goo Kim
- Department of Environmental Science, Kangwon National University, Chuncheon, South Korea
| | - Seung-Joon Lee
- Department of Internal Medicine, Kangwon National University College of Medicine, Baengnyeong-ro 256, 200-722 Chuncheon-Si, Gangwon-Do, Chuncheon, South Korea
- Environmental Health Center, Kangwon National University Hospital, Chuncheon, South Korea
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Rath N, Raje N, Rosenwasser L. Immunoglobulin E as a Biomarker in Asthma. Immunol Allergy Clin North Am 2018; 38:587-597. [PMID: 30342581 DOI: 10.1016/j.iac.2018.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Asthma is a chronic disease that affects children and adults with significant morbidity and mortality. It is multifactorial, with genetic and environmental factors affecting the overall course of the disease. Both specific and total immunoglobulin (Ig)E can be used in specific phenotypes such as allergic asthma. Using IgE as a biomarker for asthma provides a target for management and treatment. Biotherapeutics continue to emerge as important advances in asthma treatment, and their effect on IgE and its biomarker role continue to be studied.
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Affiliation(s)
- Niharika Rath
- Allergy/Immunology, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Nikita Raje
- Allergy/Immunology, Children's Mercy Hospital, University of Missouri Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Lanny Rosenwasser
- Allergy/Immunology, University of Missouri Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA.
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Sordillo JE, Switkowski KM, Coull BA, Schwartz J, Kloog I, Gibson H, Litonjua AA, Bobb J, Koutrakis P, Rifas-Shiman SL, Oken E, Gold DR. Relation of Prenatal Air Pollutant and Nutritional Exposures with Biomarkers of Allergic Disease in Adolescence. Sci Rep 2018; 8:10578. [PMID: 30002468 PMCID: PMC6043562 DOI: 10.1038/s41598-018-28216-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 06/12/2018] [Indexed: 11/09/2022] Open
Abstract
Prenatal exposures may be critical for immune system development, with consequences for allergic disease susceptibility. We examined associations of prenatal exposures (nutrient intakes and air pollutants) with allergic disease biomarkers in adolescence. We used data from 857 mother-child pairs in Project Viva, a Massachusetts-based pre-birth cohort. Outcomes of interest at follow-up (median age 12.9 years) were fractional exhaled nitric oxide (FeNO) and total serum IgE. We applied Bayesian Kernel Machine Regression analyses to estimate multivariate exposure-response functions, allowing for exposure interactions. Exposures were expressed as z-scores of log-transformed data and we report effects in % change in FeNO or IgE z-score per increase in exposure from the 25th to 75th percentile. FeNO levels were lower with higher intakes of prenatal vitamin D (-16.15%, 95% CI: -20.38 to -2.88%), folate from foods (-3.86%, 95% CI: -8.33 to 0.83%) and n-3 PUFAs (-9.21%, 95% CI -16.81 to -0.92%). Prenatal air pollutants were associated with higher FeNO and IgE, with the strongest associations detected for PM2.5 with IgE (25.6% increase, 95% CI 9.34% to 44.29%). We identified a potential synergistic interaction (p = 0.02) between vitamin E (food + supplements) and PM2.5; this exposure combination was associated with further increases in FeNO levels.
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Affiliation(s)
- Joanne E Sordillo
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Karen M Switkowski
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Brent A Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Joel Schwartz
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Itai Kloog
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Heike Gibson
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Augusto A Litonjua
- Division of Pediatric Pulmonary Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jennifer Bobb
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Diane R Gold
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Seo Y, Nonaka M, Yamamura Y, Pawankar R, Tagaya E. Optimal control of asthma improved eosinophilic otitis media. Asia Pac Allergy 2018; 8:e5. [PMID: 29423372 PMCID: PMC5796965 DOI: 10.5415/apallergy.2018.8.e5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/21/2018] [Indexed: 12/05/2022] Open
Abstract
Background Eosinophilic otitis media (EOM) is often associated with comorbid asthma. The middle ear cavity is part of the upper airway. Therefore, EOM and asthma can be considered to be a crucial part of the “one airway, one disease” phenomenon. Based on the concept of one airway, one disease in the context of allergic rhinitis and asthma, optimal level of inhalation therapy for better asthma control leads to improvement in allergic rhinitis. Objective We conducted a pilot study to determine whether appropriate strengthening of inhalation therapy for asthma is effective for EOM. Methods Fifteen patients with EOM and comorbid asthma were enrolled in this study. Eight patients were randomly selected and administered appropriately strengthened inhalation therapy for asthma (strengthened group). The effect of the therapy on EOM was assessed by comparing a questionnaire for ear symptoms, clinical characteristic score, pure tone audiometry, blood tests and temporal bone computed tomography (CT) examination before and after the therapy. Seven other EOM + asthma patients without the above mentioned therapy were included as controls. Results In the strengthened group, the score of ear symptoms, clinical characteristics score, peripheral blood eosinophil count, CT score, and air conduction hearing level improved significantly after strengthening the inhalation therapy, but not in the control group. The lung function tests (forced vital capacity [%predicted], forced expiratory volume in 1 second [FEV1] [L], and FEV1 [%predicted]) significantly increased in the strengthened group after the therapy, but not in the control group. Conclusion In this study we demonstrated that EOM improved along with improved lung function when appropriately optimal inhalation therapy was implemented in patients with EOM and asthma. Administration of optimizing therapy for asthma might be effective for concomitant EOM.
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Affiliation(s)
- Yukako Seo
- Department of Otolaryngology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Manabu Nonaka
- Department of Otolaryngology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Yukie Yamamura
- Department of Otolaryngology, Tokyo Women's Medical University, Tokyo 162-8666, Japan
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo 113-0022, Japan
| | - Etsuko Tagaya
- First Department of Medicine, Tokyo Women's Medical University, Tokyo 162-8666, Japan
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Current and future management of the young child with early onset wheezing. Curr Opin Allergy Clin Immunol 2017; 17:146-152. [PMID: 28092287 DOI: 10.1097/aci.0000000000000341] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW In this review, we discuss current thinking in relation to available guidelines for the care of preschool-aged children with recurrent wheezing, while highlighting the gaps in our knowledge and discussing changes that could occur over the next 5 years. RECENT FINDINGS The Asthma Predictive Index as well as allergen-specific IgE, peripheral eosinophil count and exhaled nitric oxide are perhaps underutilized sources of information that can assist in predicting progression to asthma and response to therapies. Inhaled corticosteroids and leukotriene receptor antagonists decrease impairment and exacerbation frequency in wheezing children but are not disease modifying. Macrolides may be useful during acute wheezing episodes for preventing progression to more severe symptoms. Monoclonal antibodies targeting IgE and TH2 cytokines have been successful in trials of adults and older children with asthma, but trials in younger children are needed. SUMMARY Establishing the phenotype and endotype of young wheezing children can be useful for prognostication of future asthma risk as well as for selection of the most appropriate treatment. Primary asthma prevention strategies are needed during the critical developmental window in early life prior to the onset of irrecoverable loss of lung function.
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Relationship between fraction of exhaled nitric oxide and airway morphology assessed by three-dimensional CT analysis in asthma. Sci Rep 2017; 7:10187. [PMID: 28860527 PMCID: PMC5579255 DOI: 10.1038/s41598-017-10504-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/09/2017] [Indexed: 11/09/2022] Open
Abstract
Fraction of exhaled nitric oxide (FeNO) provides information about chronic inflammation in asthma. However, its relationship with structural changes in the airways is unknown. We aimed to evaluate the correlation between computer-based airway changes and FeNO in patients with asthma. The wall area (WA) and airway inner luminal area (Ai) of the third- to sixth-generation bronchi were measured using three-dimensional computed tomography in asthmatic patients. Each value was corrected by body surface area (BSA). Relationships between FeNO and WA/BSA and Ai/BSA were evaluated. Forty-one clinically stable patients with asthma were evaluated. FeNO was significantly correlated with WA/BSA of the third-, fourth-, fifth- and sixth-generation bronchi (Spearman correlation coefficient (ρ) = 0.326, p = 0.041; ρ = 0.356, p = 0.025; ρ = 0.496, p = 0.002; and ρ = 0.529, p < 0.001, respectively). The correlation with sixth-generation bronchi was significantly greater than with the third-generation bronchi (p = 0.047). Partial rank correlation analysis indicated FeNO was significantly correlated with WA/BSA of the sixth-generation bronchi, independent from confounding factors of Ai/BSA, age, duration of asthma, dose of inhaled corticosteroid, blood eosinophil percentage, and blood IgE (ρ = 0.360, p = 0.034). In contrast, there was no correlation between FeNO and Ai/BSA. FeNO correlates with bronchial wall thickening in asthma patients. Measurement of FeNO may be useful to detect airway remodeling in asthma.
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Kleniewska P, Pawliczak R. The participation of oxidative stress in the pathogenesis of bronchial asthma. Biomed Pharmacother 2017; 94:100-108. [PMID: 28756367 DOI: 10.1016/j.biopha.2017.07.066] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/13/2017] [Accepted: 07/14/2017] [Indexed: 12/11/2022] Open
Abstract
Reactive oxygen species are produced during oxygen reduction and are characterized by high reactivity. They participate in many important physiological processes, but if produced in high concentrations they lead to oxidative stress development and disturb pro-oxidative/anti-oxidative balance towards the oxidation reaction - leading to damage of lipids, proteins, carbohydrates or nucleic acids. Asthma is a chronic inflammatory disease of the airways of various pathogenesis and clinical symptoms, prevalence in recent years has increased significantly. Recently published literature point out the involvement of reactive oxygen species in the pathogenesis of asthma. Changes in the protein and lipid oxidation lead, among others, to pathological changes in the respiratory epithelial cells, an increase in vascular permeability, mucus overproduction, smooth muscle contraction or airway hyperresponsiveness (AHR). The aim of this study is to present the current state of knowledge on the influence of oxidative stress parameters on asthma development.
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Affiliation(s)
- Paulina Kleniewska
- Department of Immunopathology, Faculty of Biomedical Sciences and Postgraduate Training, Medical University of Lodz, 7/9 Zeligowskiego St, bldg 2 Rm 122, 90-752 Lodz, Poland
| | - Rafał Pawliczak
- Department of Immunopathology, Faculty of Biomedical Sciences and Postgraduate Training, Medical University of Lodz, 7/9 Zeligowskiego St, bldg 2 Rm 122, 90-752 Lodz, Poland.
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Blake TL, Chang AB, Chatfield MD, Petsky HL, Rodwell LT, Brown MG, Hill DC, McElrea MS. Does Ethnicity Influence Fractional Exhaled Nitric Oxide in Healthy Individuals?: A Systematic Review. Chest 2017; 152:40-50. [PMID: 28215791 DOI: 10.1016/j.chest.2017.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/21/2016] [Accepted: 02/01/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Fractional exhaled nitric oxide (Feno) is used clinically as a biomarker of eosinophilic airway inflammation. Awareness of the factors influencing Feno values is important for valid clinical interpretation. METHODS We undertook a systematic review of PubMed, Cochrane Library, Scopus, and Web of Science databases and reference lists of included articles to evaluate whether ethnicity influences Feno values, and to determine if this influence affects clinical interpretation according to current guidelines. We included all studies that performed online Feno measurements on at least 25 healthy, non-Caucasian individuals, and examined the effect of ethnicity on Feno. RESULTS From 62 potential studies, 12 studies were included. One study recruited only children (< 12 years of age), six studies recruited children and/or adolescents, four studies recruited adults only, and a single study involved children, adolescents, and adults. In total, 16 different ethnic populations representing 11 ethnicities were studied. Ethnicity was considered a significant influencing factor in 10 of the included studies. We found the geometric mean Feno to be above the normal healthy range in two studies. We also identified five studies in which at least 5% of participants had Feno results above the age-specific inflammatory ranges. CONCLUSIONS Ethnicity influences Feno values, and for some ethnic groups this influence likely affects clinical interpretation according to current guidelines. There is a need to establish healthy Feno reference ranges for specific ethnic groups to improve clinical application.
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Affiliation(s)
- Tamara L Blake
- Queensland University of Technology, Centre for Children's Health Research, South Brisbane, QLD, Australia; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia.
| | - Anne B Chang
- Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia
| | - Helen L Petsky
- Queensland University of Technology, Centre for Children's Health Research, South Brisbane, QLD, Australia
| | - Leanne T Rodwell
- Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia
| | - Michael G Brown
- Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Deb C Hill
- Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Margaret S McElrea
- Queensland University of Technology, Centre for Children's Health Research, South Brisbane, QLD, Australia; Indigenous Respiratory Outreach Care Program, The Prince Charles Hospital, Chermside, QLD, Australia; Department of Respiratory and Sleep Medicine, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia
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Högman M, Lehtimäki L, Dinh-Xuan AT. Utilising exhaled nitric oxide information to enhance diagnosis and therapy of respiratory disease - current evidence for clinical practice and proposals to improve the methodology. Expert Rev Respir Med 2017; 11:101-109. [PMID: 28076986 DOI: 10.1080/17476348.2017.1281746] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION A non-invasive tool to diagnose respiratory diseases and to follow treatment has long been looked-for. Exhaled nitric oxide (NO) is a promising marker of inflammation in asthma but nearly 25-years of research has shown that it works in only certain endotypes of asthma. The modelling of NO dynamics of the lung can give more information than a single FENO value. Areas covered: The estimation of the NO production in the conducting airways and in the gas exchange area has given new insight of the NO production in diseases beyond asthma. In this article, we discuss the importance of methodology for NO measurement in the exhaled breath and the indication of applying this technique to detect respiratory disorders. This narrative review is an attempt to examine and discuss the physiological basis underlying exhaled NO measurements and the clinical evidence of the usefulness of this method in asthma and various other respiratory disorders. Expert commentary: Estimation of the NO parameters would aid in our understanding of the NO dynamics of the lung and thereby give more knowledge how to interpret the measured FENO value in clinical practice.
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Affiliation(s)
- Marieann Högman
- a Department of Medical Sciences, Lung- Allergy- and Sleep Research , Uppsala University , Uppsala , Sweden
| | - Lauri Lehtimäki
- b Allergy Centre , Tampere University Hospital , Tampere , Finland.,c Medical School , University of Tampere , Tampere , Finland
| | - Anh Tuan Dinh-Xuan
- d Department of Respiratory Physiology , Cochin Hospital & Paris Descartes University , Paris , France
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Park YA, Park HB, Kim YH, Sul IS, Yoon SH, Kim HR, Kim KW, Kim KE, Sohn MH. Airway hyperresponsiveness to mannitol and methacholine and exhaled nitric oxide in children with asthma. J Asthma 2017; 54:644-651. [PMID: 28055271 DOI: 10.1080/02770903.2016.1255751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Asthma is characterized by airway hyperresponsiveness (AHR), inflammation, and obstruction. AHR to stimuli that indirectly cause bronchial smooth muscle (BSM) contractions via release of endogenous mediators is thought to better reflect airway inflammation than AHR to stimuli that act directly on BSM. Fractional exhaled nitric oxide (FeNO) is a useful parameter for noninvasive clinical airway inflammation assessments. Accordingly, this study aimed to examine the relationships of mannitol and methacholine challenge test outcomes with FeNO and the influence of inhaled corticosteroid treatment in children with asthma. METHODS One hundred thirty-four asthmatic children (89 males; ages: 5-17 years, median: 9 years) underwent spirometry, FeNO measurement, serum total/specific IgE testing, and blood eosinophil count. All subjects were challenged with mannitol dry powder (MDP; AridolH, Pharmaxis, Australia) and methacholine at 7-day intervals. Data of steroid-treated and steroid-naïve children were compared. RESULTS Positive responses to MDP and methacholine challenge tests were observed in 74.6% and 67.2% of total subject group, respectively, and 72 children had positive response to both challenge tests. The median FeNO level, response-dose ratio (RDR) of PC20 methacholine, and RDR of PD15 MDP were significantly higher in the steroid-treated group than in the steroid-naïve group (p < 0.001, 0.226, and 0.004, respectively). FeNO levels associated significantly with PD15 MDP and RDR PD15 MDP in total subject populations (p = 0.016 and 0.003, respectively); however, a significant correlation between FeNO and RDR PD15 MDP was observed only in the steroid-naïve group. CONCLUSIONS Compared with AHR to methacholine, AHR to MDP more closely reflected the level of FeNO in steroid-naïve asthmatic children.
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Affiliation(s)
- Young A Park
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Hyun Bin Park
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Yoon Hee Kim
- b Gangnam Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - In Sook Sul
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Seo Hee Yoon
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Hye Ran Kim
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Kyung Won Kim
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
| | - Kyu-Earn Kim
- b Gangnam Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine , Seoul , Republic of Korea
| | - Myung Hyun Sohn
- a Department of Pediatrics , Severance Children's Hospital , Seoul , Republic of Korea
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Kwon JW, Song WJ, Kim MH, Lim KH, Yang MS, Jung JW, Lee J, Suh DI, Shin YS, Kim SH, Kim SH, Lee BJ, Cho SH. The KAAACI Standardization Committee Report on the procedure and application of fractional exhaled nitric oxide measurement. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.4.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung-Hwan Lim
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeongmin Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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ASMA SEVERA PROBLEMÁTICA EN PEDIATRÍA. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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