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Rossi A, Butorac-Petanjek B, Chilosi M, Cosío BG, Flezar M, Koulouris N, Marin J, Miculinic N, Polese G, Samaržija M, Skrgat S, Vassilakopoulos T, Vukić-Dugac A, Zakynthinos S, Miravitlles M. Chronic obstructive pulmonary disease with mild airflow limitation: current knowledge and proposal for future research - a consensus document from six scientific societies. Int J Chron Obstruct Pulmon Dis 2017; 12:2593-2610. [PMID: 28919728 PMCID: PMC5587130 DOI: 10.2147/copd.s132236] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity worldwide, with high and growing prevalence. Its underdiagnosis and hence under-treatment is a general feature across all countries. This is particularly true for the mild or early stages of the disease, when symptoms do not yet interfere with daily living activities and both patients and doctors are likely to underestimate the presence of the disease. A diagnosis of COPD requires spirometry in subjects with a history of exposure to known risk factors and symptoms. Postbronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity <0.7 or less than the lower limit of normal confirms the presence of airflow limitation, the severity of which can be measured by FEV1% predicted: stage 1 defines COPD with mild airflow limitation, which means postbronchodilator FEV1 ≥80% predicted. In recent years, an elegant series of studies has shown that "exclusive reliance on spirometry, in patients with mild airflow limitation, may result in underestimation of clinically important physiologic impairment". In fact, exercise tolerance, diffusing capacity, and gas exchange can be impaired in subjects at a mild stage of airflow limitation. Furthermore, growing evidence indicates that smokers without overt abnormal spirometry have respiratory symptoms and undergo therapy. This is an essential issue in COPD. In fact, on one hand, airflow limitation, even mild, can unduly limit the patient's physical activity, with deleterious consequences on quality of life and even survival; on the other hand, particularly in younger subjects, mild airflow limitation might coincide with the early stage of the disease. Therefore, we thought that it was worthwhile to analyze further and discuss this stage of "mild COPD". To this end, representatives of scientific societies from five European countries have met and developed this document to stimulate the attention of the scientific community on COPD with "mild" airflow limitation. The aim of this document is to highlight some key features of this important concept and help the practicing physician to understand better what is behind "mild" COPD. Future research should address two major issues: first, whether mild airflow limitation represents an early stage of COPD and what the mechanisms underlying the evolution to more severe stages of the disease are; and second, not far removed from the first, whether regular treatment should be considered for COPD patients with mild airflow limitation, either to prevent progression of the disease or to encourage and improve physical activity or both.
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Affiliation(s)
- Andrea Rossi
- Pulmonary Unit, University of Verona, Verona, Italy
| | | | | | - Borja G Cosío
- Department of Respiratory Medicine, Hospital Son Espases-IdISPa and CIBERES, Palma, Spain
| | - Matjaz Flezar
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Nikolaos Koulouris
- First Department of Respiratory Medicine, Medical School of National and Kapodistrian University of Athens, Greece
| | - José Marin
- Respiratory Medicine, Hospital Universitario Miguel Servet, CIBERES & IISAragon, Zaragoza, Spain
| | - Neven Miculinic
- Respiratory Department, University Hospital Centre, Zagreb, Croatia
| | | | - Miroslav Samaržija
- Jordanovac Department for Respiratory Diseases, University of Zagreb School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Sabina Skrgat
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - Theodoros Vassilakopoulos
- First Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens, Greece
| | - Andrea Vukić-Dugac
- Jordanovac Department for Respiratory Diseases, University of Zagreb School of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Spyridon Zakynthinos
- First Department of Critical Care and Pulmonary Services, Evangelismos Hospital, University of Athens, Greece
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitary Vall d'Hebron, Barcelona, Spain
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352
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Chipps BE, Haselkorn T, Paknis B, Ortiz B, Bleecker ER, Kianifard F, Foreman AJ, Szefler SJ, Zeiger RS. More than a decade follow-up in patients with severe or difficult-to-treat asthma: The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) II. J Allergy Clin Immunol 2017; 141:1590-1597.e9. [PMID: 28797732 DOI: 10.1016/j.jaci.2017.07.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 07/10/2017] [Accepted: 07/19/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR I) study demonstrated high morbidity in patients with severe or difficult-to-treat asthma despite standard-of-care treatment. OBJECTIVE We sought to determine the long-term natural history of disease and outcomes in patients in TENOR I after more than a decade. METHODS TENOR I was a multicenter observational study (2001-2004) of 4756 patients with severe or difficult-to-treat asthma. TENOR II was a follow-up study of TENOR I patients using a single cross-sectional visit in 2013/2014. Overall, the sites participating in TENOR II originally enrolled 1230 patients in TENOR I. Clinical and patient-reported outcomes were assessed, including very poorly controlled asthma based on National Heart, Lung, and Blood Institute guidelines. RESULTS A total of 341 (27.7%) patients were enrolled in TENOR II and were representative of the TENOR I cohort. The most frequent comorbidities were rhinitis (84.0%), sinusitis (47.8%), and gastroesophageal reflux disease (46.3%). Mean percent predicted prebronchodilator and postbronchodilator FEV1 were 72.7% (SD, 21.4%) and 78.2% (SD, 20.7%), respectively. A total of 231 (72.9%) of 317 patients had positive test responses to 1 or more allergen-specific IgEs. The mean blood eosinophil count was 200/μL (SD, 144/μL). Eighty-eight (25.8%) patients experienced an asthma exacerbation in the prior 3 months requiring hospital attention, oral corticosteroids, or both. More than half (197/339 [58.1%]) had very poorly controlled asthma. Medication use suggested undertreatment. CONCLUSION TENOR II provides longitudinal data to characterize disease progression, heterogeneity, and severity in patients with severe or difficult-to-treat asthma. Findings show continued morbidity, including a high degree of comorbid conditions, allergic sensitization, exacerbations, and very poorly controlled asthma, including reduced lung function.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, Calif.
| | | | | | | | - Eugene R Bleecker
- Center for Genomics & Personalized Medicine, Section of Pulmonary & Critical Care Medicine, Wake Forest University, Winston-Salem, NC
| | | | | | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital, Colorado, Aurora, Colo
| | - Robert S Zeiger
- Department of Allergy, Kaiser Permanente Southern California, San Diego, Calif
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353
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Berry CE, Billheimer D, Jenkins IC, Lu ZJ, Stern DA, Gerald LB, Carr TF, Guerra S, Morgan WJ, Wright AL, Martinez FD. A Distinct Low Lung Function Trajectory from Childhood to the Fourth Decade of Life. Am J Respir Crit Care Med 2017; 194:607-12. [PMID: 27585385 DOI: 10.1164/rccm.201604-0753oc] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
RATIONALE Low maximally attained lung function increases the risk of chronic obstructive pulmonary disease irrespective of the subsequent rate of lung function decline. OBJECTIVES We aimed to determine if there were individuals with a distinct, persistently low lung function trajectory in the CRS (Tucson Children's Respiratory Study). METHODS The CRS, an ongoing birth cohort study, enrolled 1,246 participants between 1980 and 1984. Latent class linear mixed effects modeling of the ratio of FEV1 to FVC was used to identify distinct lung function trajectories among participants with two or more spirometry measurements between ages 11 and 32 years. MEASUREMENTS AND MAIN RESULTS Among 599 participants with 2,142 observations, a model with two distinct trajectories (a low trajectory [n = 56; 9.3%] and a normal trajectory) fit the data significantly better than a model with only one trajectory (P = 0.0007). As compared with those with a normal trajectory, participants with a persistently low trajectory were more likely to have a history of maternal asthma (20.0% vs. 9.9%; P = 0.02); early life lower respiratory illness caused by respiratory syncytial virus (41.2% vs. 21.4%; P = 0.001); and physician-diagnosed active asthma at age 32 years (43.9% vs. 16.2%; P < 0.001). Individuals with a persistently low trajectory also demonstrated lower lung function as measured by average maximal expiratory flow at functional residual capacity during infancy and at age 6 years. CONCLUSIONS A distinct group of individuals in a nonselected population demonstrates a persistently low lung function trajectory that may be partly established at birth and predisposes them to chronic obstructive pulmonary disease later in life.
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Affiliation(s)
| | - Dean Billheimer
- 3 BIO5 Institute, University of Arizona, Tucson, Arizona.,4 Department of Epidemiology and Biostatistics and
| | - Isaac C Jenkins
- 5 Fred Hutchinson Cancer Research Center, Seattle, Washington; and
| | - Zhenqiang J Lu
- 3 BIO5 Institute, University of Arizona, Tucson, Arizona
| | | | - Lynn B Gerald
- 2 Arizona Respiratory Center and.,6 Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Tara F Carr
- 1 Department of Medicine and.,2 Arizona Respiratory Center and
| | - Stefano Guerra
- 1 Department of Medicine and.,2 Arizona Respiratory Center and.,7 CREAL Center, Pompeu Fabra University, Barcelona, Spain
| | - Wayne J Morgan
- 8 Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona.,2 Arizona Respiratory Center and
| | - Anne L Wright
- 8 Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona.,2 Arizona Respiratory Center and
| | - Fernando D Martinez
- 8 Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona.,2 Arizona Respiratory Center and.,3 BIO5 Institute, University of Arizona, Tucson, Arizona
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354
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Luzak A, Fuertes E, Flexeder C, Standl M, von Berg A, Berdel D, Koletzko S, Heinrich J, Nowak D, Schulz H. Which early life events or current environmental and lifestyle factors influence lung function in adolescents? - results from the GINIplus & LISAplus studies. Respir Res 2017; 18:138. [PMID: 28701166 PMCID: PMC5508705 DOI: 10.1186/s12931-017-0619-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 07/03/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Various factors may affect lung function at different stages in life. Since investigations that simultaneously consider several factors are rare, we examined the relative importance of early life, current environmental/lifestyle factors and allergic diseases on lung function in 15-year-olds. METHODS Best subset selection was performed for linear regression models to investigate associations between 21 diverse early life events and current factors with spirometric parameters (forced vital capacity, forced expiratory volume in 1 s and maximal mid-expiratory flow (FEF25-75)) in 1326 participants of the German GINIplus and LISAplus birth cohorts. To reduce model complexity, one model for each spirometric parameter was replicated 1000 times in random subpopulations (N = 884). Only those factors that were included in >70% of the replication models were retained in the final analysis. RESULTS A higher peak weight velocity and early lung infections were the early life events prevalently associated with airflow limitation and FEF25-75. Current environmental/lifestyle factors at age 15 years and allergic diseases that were associated with lung function were: indoor second-hand smoke exposure, vitamin D concentration, body mass index (BMI) and asthma status. Sex and height captured the majority of the explained variance (>75%), followed by BMI (≤23.7%). The variance explained by early life events was comparatively low (median: 4.8%; range: 0.2-22.4%), but these events were consistently negatively associated with airway function. CONCLUSIONS Although the explained variance was mainly captured by well-known factors included in lung function prediction equations, our findings indicate early life and current factors that should be considered in studies on lung health among adolescents.
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Affiliation(s)
- Agnes Luzak
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology I, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Elaine Fuertes
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology I, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,ISGlobal, Centre for Research in Environmental Epidemiology (CREAL), Doctor Aiguader 88, 08003, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Plaça de la Mercè 10, 08002, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5. Pabellón 11, 28029, Madrid, Spain
| | - Claudia Flexeder
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology I, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Marie Standl
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology I, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany
| | - Andrea von Berg
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, Pastor-Janßen-Str. 8-38, 46483, Wesel, Germany
| | - Dietrich Berdel
- Department of Pediatrics, Research Institute, Marien-Hospital Wesel, Pastor-Janßen-Str. 8-38, 46483, Wesel, Germany
| | - Sibylle Koletzko
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstr. 4, 80337, Munich, Germany
| | - Joachim Heinrich
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology I, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Max-Lebsche-Platz 31, 81377, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany
| | - Dennis Nowak
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Max-Lebsche-Platz 31, 81377, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich (LMU), Ziemssenstr. 1, 80336, Munich, Germany
| | - Holger Schulz
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology I, Ingolstädter Landstr. 1, 85764, Neuherberg, Germany. .,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research, Max-Lebsche-Platz 31, 81377, Munich, Germany.
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355
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Anderson WC, Apter AJ, Dutmer CM, Searing DA, Szefler SJ. Advances in asthma in 2016: Designing individualized approaches to management. J Allergy Clin Immunol 2017; 140:671-680. [PMID: 28709967 DOI: 10.1016/j.jaci.2017.06.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 12/12/2022]
Abstract
In this year's Advances in Asthma review, we discuss viral infections in asthmatic patients and potential therapeutic agents, the microbiome, novel genetic associations with asthma, air quality and climate effects on asthma, exposures during development and long-term sequelae of childhood asthma, patient-centered outcomes research, and precision medicine. In addition, we discuss application of biomarkers to precision medicine and new information on asthma medications. New evidence indicates that rhinovirus-triggered asthma exacerbations become more severe as the degree of sensitization to dust mite and mouse increase. The 2 biggest drivers of asthma severity are an allergy pathway starting with allergic sensitization and an environmental tobacco smoke pathway. In addition, allergic sensitization and blood eosinophils can be used to select medications for management of early asthma in young children. These current findings, among others covered in this review, represent significant steps toward addressing rapidly advancing areas of knowledge that have implications for asthma management.
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Affiliation(s)
- William C Anderson
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Andrea J Apter
- Section of Allergy & Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa
| | - Cullen M Dutmer
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Daniel A Searing
- Allergy & Immunology Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Stanley J Szefler
- Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
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356
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Athanazio R, Cukier A. Phenotyping asthma: More complex than just age. Respirology 2017; 22:1485-1486. [PMID: 28691285 DOI: 10.1111/resp.13120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 06/15/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Rodrigo Athanazio
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alberto Cukier
- Pulmonary Division, Heart Institute (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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357
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Abstract
PURPOSE OF REVIEW The aim of this study is to characterize, diagnose, evaluate, and treat severe childhood asthma. RECENT FINDINGS Understanding the occurrence of the physiologic and clinical presentations of childhood severe asthma, the treatment and response may be predicted by biomarkers, but the patient's response is highly variable. The onset of severe asthma occurs early and is primarily predicted by severity of viral infection and coexistence of the atopic state.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, 5609 J Street, Suite C, Sacramento, CA, 95819, USA.
| | - Neil G Parikh
- Capital Allergy and Respiratory Disease Center, 5609 J Street, Suite C, Sacramento, CA, 95819, USA
| | - Sheena K Maharaj
- Capital Allergy and Respiratory Disease Center, 5609 J Street, Suite C, Sacramento, CA, 95819, USA
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358
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Fritzsching B. [Not Available]. MMW Fortschr Med 2017; 159:36. [PMID: 28718122 DOI: 10.1007/s15006-017-9896-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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359
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A History of Asthma From Childhood and Left Ventricular Mass in Asymptomatic Young Adults: The Bogalusa Heart Study. JACC-HEART FAILURE 2017; 5:497-504. [PMID: 28662937 DOI: 10.1016/j.jchf.2017.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/15/2017] [Accepted: 03/15/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This study aimed to examine whether a history of asthma from childhood is associated with left ventricular (LV) mass in adulthood. BACKGROUND Asthma has been related to various cardiovascular risk factors affecting LV hypertrophy. The authors saw a need for a prospective study to analyze the relationship between a history of asthma from childhood and markers of LV mass among asymptomatic young adults. METHODS Prospective analyses were performed among 1,118 Bogalusa Heart Study participants (average age at follow-up 36.7 ± 5.1 years), with a baseline history of self-reported asthma collected since childhood (average age at baseline 26.8 ± 10.1 years). LV mass (g) was assessed using 2-dimensional guided M-mode echocardiography and was indexed for body height (m2.7) as LV mass index (LVMI; g/m2.7). A multivariate linear mixed model was fitted for the repeated measures. RESULTS After an average of 10.4 ± 7.5 years of follow-up, participants with a history of asthma from childhood had a greater LV mass (167.6 vs. 156.9; p = 0.01) and LVMI (40.7 vs. 37.7; p < 0.01) with adjustment for age, sex, race, smoking status, antihypertensive medication, heart rate, and systolic blood pressure (SBP). The difference of LVMI between group with asthma and the group without asthma remained significant after additional adjustment for body mass index (39.0 vs. 37.1; p = 0.03) and high-sensitivity C-reactive protein (38.4 vs. 36.6; p = 0.04). In addition, the authors found significant interactions between SBP and asthma on LV mass and LVMI (p for interaction <0.01, respectively). The associations between asthma and LV measures appeared to be stronger among pre-hypertensive and hypertensive participants (SBP ≥130 mm Hg) compared with participants with normal SBP (<130 mm Hg) (regression coefficient: 39.5 vs. 2.3 for LV mass and 9.0 vs. 0.9 for LVMI). CONCLUSIONS The findings of this study indicate that a history of asthma is associated with higher LVMI, and this association is stronger among participants with pre-hypertension and hypertension.
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360
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Abstract
Recent years have witnessed critical contributions to our understanding of the determinants and long-term implications of lung function development. In this article, we review studies that have contributed to advances in understanding lung function development and its critical importance for lung health into adult life. In particular, we have focused on early life determinants that include genetic factors, perinatal events, environmental exposures, lifestyle, infancy lower respiratory tract infections, and persistent asthma phenotypes. Longitudinal studies have conclusively demonstrated that lung function deficits that are established by school age may track into adult life and increase the risk of adult lung obstructive diseases, such as chronic obstructive pulmonary disease. Furthermore, these contributions have provided initial evidence in support of a direct influence by early life events on an accelerated decline of lung function and an increased susceptibility to its environmental determinants well into adult life. As such, we argue that future health-care programs based on precision medicine approaches that integrate deep phenotyping with tailored medication and advice to patients should also foster optimal lung function growth to be fully effective.
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Affiliation(s)
- Erik Melén
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Sachs' Children's Hospital, Södersjukhuset, Stockholm, Sweden.,Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Stefano Guerra
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA.,ISGlobal Center for Research in Environmental Epidemiology, Barcelona, Spain
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361
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Just J, Bourgoin-Heck M, Amat F. Clinical phenotypes in asthma during childhood. Clin Exp Allergy 2017; 47:848-855. [PMID: 28422351 DOI: 10.1111/cea.12939] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Asthma is a heterogeneous disease characterized by numerous phenotypes relating to age of onset, triggers, comorbidities, severity (assessed by multiple exacerbations, lung function pattern) and finally the inflammatory cells involved in the pathophysiologic pathway. These phenotypes can vary over time in relation to changes in the principal triggers involved in the aetiology of the disease. Nevertheless, in a patient with multiple allergies and early-onset disease (defined as multiple sensitizations and allergic comorbidities), the prognosis of asthma is poor with a high risk of persistence and severity of the disease during childhood. Future research will focus on classifying phenotypes into groups based on pathophysiologic mechanisms (endotypes) and the biomarkers attached to these endotypes, which could predict prognosis and lead to targeted therapy. Currently, these biomarkers are related to inflammatory cells associated with the asthma endotype, essentially eosinophils and neutrophils (and related cytokines) attached to Th-2 and non Th-1 pathways, respectively. The most severe asthma (refractory asthma) is linked to neutrophil-derived inflammation (frequently associated with female sex, obesity and possibly disorganized airway microbiota) encountered in very young children or teenagers. Severe asthma is also linked to or a marked eosinophil inflammatory process (frequently associated with multiple atopy and, more rarely, with non-atopic hypereosinophilic asthma in children) and frequently encountered in teenagers. Severe phenotypes of asthma could also play a role in the origin of chronic obstructive pulmonary disease in adult life.
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Affiliation(s)
- J Just
- Service d'Allergologie, Centre de l'Asthme et des Allergies, AP-HP, Groupe hospitalier Trousseau-La Roche Guyon, Paris, France.,EPAR, UMR-S 1136 INSERM & UPMC Paris6, Université Paris Pierre et Marie Curie, Paris, France
| | - M Bourgoin-Heck
- Service d'Allergologie, Centre de l'Asthme et des Allergies, AP-HP, Groupe hospitalier Trousseau-La Roche Guyon, Paris, France.,EPAR, UMR-S 1136 INSERM & UPMC Paris6, Université Paris Pierre et Marie Curie, Paris, France
| | - F Amat
- Service d'Allergologie, Centre de l'Asthme et des Allergies, AP-HP, Groupe hospitalier Trousseau-La Roche Guyon, Paris, France.,EPAR, UMR-S 1136 INSERM & UPMC Paris6, Université Paris Pierre et Marie Curie, Paris, France
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362
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Maas BM, Wang J, Cooner F, Green D, Yuan Y, Yao L, Burckart GJ. Bone Mineral Density to Assess Pediatric Bone Health in Drug Development. Ther Innov Regul Sci 2017; 51:756-760. [PMID: 30227097 DOI: 10.1177/2168479017709047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Pediatric bone health is an important part of the safety assessment of inhaled corticosteroids and certain other drugs. Current regulatory guidance for assessment of bone health for intranasal and inhaled corticosteroid drugs is a single 1-year study of linear growth. OBJECTIVE The objective of this study was to assess whether a significant change in bone mineral density (BMD) could be observed during a 12-month period in pediatric patients being treated for asthma with an inhaled corticosteroid using a previously conducted study. METHODS The publicly available information from the Childhood Asthma Management Program (CAMP) study was used to assess whether a statistically significant difference in BMD could be detected over a 1-year period. Patients who were at Tanner stage ≥2 were excluded from analysis as is stated in the present FDA Guidance on growth studies with inhaled corticosteroids, and children with any use of oral corticosteroids were also excluded. A comparison in BMD change over time (bone mineral accretion [BMA]) between baseline and 12 months of follow-up was made for the placebo and inhaled budesonide groups using multiple regression analysis to account for age, race, and gender as covariates. RESULTS From the original 1041 patients in the CAMP study, 74 patients met the criteria for evaluation, with 42 patients receiving budesonide and 32 placebo patients. Children randomized to budesonide had a lower mean BMA than those receiving placebo (0.021 ± 0.023 [SD] g/cm2/y vs 0.036 ± 0.025 [SD] g/cm2/y). CONCLUSION In a select pediatric patient population, a significant change in BMA can be observed over 12 months on an inhaled corticosteroid. Based on this post hoc analysis, measurement of BMA as an assessment of pediatric bone health may be considered for certain drugs, especially when there is a potential signal of bone toxicity from animal or human data. The clinical relevance of this finding is presently unknown, and more data on the relationship between changes in BMA and clinical pediatric bone health outcomes are needed.
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Affiliation(s)
- Brian M Maas
- 1 University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Jian Wang
- 2 Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Freda Cooner
- 3 Office of Biostatistics, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Dionna Green
- 4 Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, USA
| | - Ye Yuan
- 5 University of Florida, Gainesville, FL, USA
| | - Lynne Yao
- 2 Office of New Drugs, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Gilbert J Burckart
- 4 Office of Clinical Pharmacology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, USA
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363
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Bush A, Custovic A. Formula one: best is no formula. Eur Respir J 2017; 49:49/5/1700105. [PMID: 28461302 DOI: 10.1183/13993003.00105-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/17/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Andrew Bush
- Royal Brompton Hospital, London, UK .,Imperial College, London, UK
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364
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Naveed SUN, Clements D, Jackson DJ, Philp C, Billington CK, Soomro I, Reynolds C, Harrison TW, Johnston SL, Shaw DE, Johnson SR. Matrix Metalloproteinase-1 Activation Contributes to Airway Smooth Muscle Growth and Asthma Severity. Am J Respir Crit Care Med 2017; 195:1000-1009. [PMID: 27967204 DOI: 10.1164/rccm.201604-0822oc] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Matrix metalloproteinase-1 (MMP-1) and mast cells are present in the airways of people with asthma. OBJECTIVES To investigate whether MMP-1 could be activated by mast cells and increase asthma severity. METHODS Patients with stable asthma and healthy control subjects underwent spirometry, methacholine challenge, and bronchoscopy, and their airway smooth muscle cells were grown in culture. A second asthma group and control subjects had symptom scores, spirometry, and bronchoalveolar lavage before and after rhinovirus-induced asthma exacerbations. Extracellular matrix was prepared from decellularized airway smooth muscle cultures. MMP-1 protein and activity were assessed. MEASUREMENTS AND MAIN RESULTS Airway smooth muscle cells generated pro-MMP-1, which was proteolytically activated by mast cell tryptase. Airway smooth muscle treated with activated mast cell supernatants produced extracellular matrix, which enhanced subsequent airway smooth muscle growth by 1.5-fold (P < 0.05), which was dependent on MMP-1 activation. In asthma, airway pro-MMP-1 was 5.4-fold higher than control subjects (P = 0.002). Mast cell numbers were associated with airway smooth muscle proliferation and MMP-1 protein associated with bronchial hyperresponsiveness. During exacerbations, MMP-1 activity increased and was associated with fall in FEV1 and worsening asthma symptoms. CONCLUSIONS MMP-1 is activated by mast cell tryptase resulting in a proproliferative extracellular matrix. In asthma, mast cells are associated with airway smooth muscle growth, MMP-1 levels are associated with bronchial hyperresponsiveness, and MMP-1 activation are associated with exacerbation severity. Our findings suggest that airway smooth muscle/mast cell interactions contribute to asthma severity by transiently increasing MMP activation, airway smooth muscle growth, and airway responsiveness.
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Affiliation(s)
- Shams-Un-Nisa Naveed
- 1 Division of Respiratory Medicine and Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Debbie Clements
- 1 Division of Respiratory Medicine and Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - David J Jackson
- 2 National Heart and Lung Institute, Imperial College London and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom.,3 Respiratory Medicine, Guy's and St Thomas' NHS Trust, London, United Kingdom; and
| | - Christopher Philp
- 1 Division of Respiratory Medicine and Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte K Billington
- 1 Division of Respiratory Medicine and Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Irshad Soomro
- 4 Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Catherine Reynolds
- 1 Division of Respiratory Medicine and Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Timothy W Harrison
- 1 Division of Respiratory Medicine and Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Sebastian L Johnston
- 2 National Heart and Lung Institute, Imperial College London and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
| | - Dominick E Shaw
- 1 Division of Respiratory Medicine and Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
| | - Simon R Johnson
- 1 Division of Respiratory Medicine and Respiratory Research Unit, University of Nottingham, Nottingham, United Kingdom
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365
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Qin XD, Qian ZM, Dharmage SC, Perret J, Geiger SD, Rigdon SE, Howard S, Zeng XW, Hu LW, Yang BY, Zhou Y, Li M, Xu SL, Bao WW, Zhang YZ, Yuan P, Wang J, Zhang C, Tian YP, Nian M, Xiao X, Chen W, Lee YL, Dong GH. Association of perfluoroalkyl substances exposure with impaired lung function in children. ENVIRONMENTAL RESEARCH 2017; 155:15-21. [PMID: 28171771 DOI: 10.1016/j.envres.2017.01.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/02/2017] [Accepted: 01/20/2017] [Indexed: 05/21/2023]
Abstract
Previous studies have demonstrated associations between serum levels of perfluoroalkyl substances (PFASs) and asthma or asthma related-biomarkers. However, no studies have reported a possible relationship between PFASs exposure and lung function among children. The objective of the present study is to test the association between PFASs exposure and lung function in children from a high exposure area by using a cross-sectional case-control study, which included 132 asthmatic children and 168 non-asthmatic controls recruited from 2009 to 2010 in the Genetic and Biomarkers study for Childhood Asthma. Structured questionnaires were administered face-to-face. Lung function was measured by spirometry. Linear regression models were used to examine the influence of PFASs on lung function. The results showed that asthmatics in our study had significantly higher serum PFAS concentrations than healthy controls. Logistic regression models showed a positive association between PFASs and asthma, with adjusted odds ratios (ORs) ranging from 0.99 (95% confidence interval [CI]: 0.80-1.21) to 2.76 (95% CI: 1.82-4.17). Linear regression modeling showed serum PFASs levels were significantly negatively associated with three pulmonary function measurements (forced vital capacity: FVC; forced expiratory volume in 1s: FEV1; forced expiratory flow 25-75%: FEF25-75) among children with asthma, the adjusted coefficients between lung function and PFASs exposure ranged from -0.055 (95%CI: -0.100 to -0.010) for FVC and perfluorooctane sulfonate (PFOS) to -0.223 (95%CI: -0.400 to -0.045) for FEF25-75 and perfluorooctanoic acid (PFOA). PFASs were not, however, significantly associated with pulmonary function among children without asthma. In conclusion, this study suggests that serum PFASs are associated with decreased lung function among children with asthma.
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Affiliation(s)
- Xiao-Di Qin
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Zhengmin Min Qian
- Department of Epidemiology, College for Public Health and Social Justice, Saint Louis University, Saint Louis 63104, USA
| | - Shyamali C Dharmage
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic 3052, Australia
| | - Jennifer Perret
- Allergy and Lung Health Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Vic 3052, Australia
| | - Sarah Dee Geiger
- School of Health Studies, Northern Illinois University, DeKalb, IL 60115, USA
| | - Steven E Rigdon
- Department of Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis 63104, USA
| | - Steven Howard
- Department of Health Management & Policy, College for Public Health and Social Justice, Saint Louis University, Saint Louis 63104, USA
| | - Xiao-Wen Zeng
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Li-Wen Hu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Bo-Yi Yang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yang Zhou
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Meng Li
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Shu-Li Xu
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wen-Wen Bao
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ya-Zhi Zhang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Ping Yuan
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Jia Wang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Chuan Zhang
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yan-Peng Tian
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Min Nian
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Xiang Xiao
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Wen Chen
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yungling Leo Lee
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 100, Taiwan.
| | - Guang-Hui Dong
- Guangzhou Key Laboratory of Environmental Pollution and Health Risk Assessment, Department of Preventive Medicine, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China.
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366
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Cook J, Beresford F, Fainardi V, Hall P, Housley G, Jamalzadeh A, Nightingale M, Winch D, Bush A, Fleming L, Saglani S. Managing the pediatric patient with refractory asthma: a multidisciplinary approach. J Asthma Allergy 2017; 10:123-130. [PMID: 28461761 PMCID: PMC5404805 DOI: 10.2147/jaa.s129159] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Children with asthma that is refractory to high levels of prescribed treatment are described as having problematic severe asthma. Those in whom persistent symptoms result from a failure of basic asthma management are described as having "difficult asthma", while those who remain symptomatic despite these factors having been addressed are described as having "severe therapy-resistant asthma" (STRA). The majority of children have difficult asthma; asthma that is poorly controlled because of a failure to get the basics of asthma management right. Modifiable factors including nonadherence to medication, persistent adverse environmental exposures, and psychosocial factors often contribute to poor control in these patients. As our skill in identifying and addressing modifiable factors has improved, we have found that a progressively smaller proportion of our clinic patients is categorized as having true STRA, resulting in an infrequent resort to escalation of treatment. Many of the modifiable factors associated with the diagnosis of difficult asthma can be identified in a general pediatric clinic. Characterization of more complex factors, however, requires the time, skill, and expertise of multiple health care professionals within the asthma multidisciplinary team. In this review, we will describe the structured approach adopted by The Royal Brompton Hospital in the management of the child with problematic severe asthma. We highlight the roles of members of the multidisciplinary team at various stages of assessment and focus on prominent themes in the identification and treatment of modifiable factors.
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Affiliation(s)
- James Cook
- Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Fran Beresford
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Valentina Fainardi
- Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London
| | - Pippa Hall
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Georgie Housley
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | | | | | - David Winch
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Andrew Bush
- Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Louise Fleming
- Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
| | - Sejal Saglani
- Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London
- Respiratory Paediatrics, Royal Brompton Hospital, London, UK
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367
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Childhood asthma is a risk factor for the development of chronic obstructive pulmonary disease. Curr Opin Allergy Clin Immunol 2017; 17:104-109. [PMID: 28118239 PMCID: PMC5577926 DOI: 10.1097/aci.0000000000000348] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW This review will catalog the many recent longitudinal studies that have investigated the relationship between asthma and lung function, or the persistence and trajectories of lung function deficits. RECENT FINDINGS Recent work has reported on 50-year follow-ups of some prominent population cohorts. A history of asthma confers a 10-30-fold risk of chronic obstructive pulmonary disease. Individuals reaching a reduced maximum growth of forced expiratory volume in 1 s in early adulthood are at risk for early or more severe chronic obstructive pulmonary disease (COPD). SUMMARY Taken together, there is a wealth of overlapping cohort studies of lung function, asthma and COPD. These show that asthma is associated with reduced lung function, which may start in infancy or prenatally, persists through childhood and adulthood and predisposes for early or more severe COPD.
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368
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Lee-Sarwar KA, Bacharier LB, Litonjua AA. Strategies to alter the natural history of childhood asthma. Curr Opin Allergy Clin Immunol 2017; 17:139-145. [PMID: 28079559 PMCID: PMC5664210 DOI: 10.1097/aci.0000000000000340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Asthma exhibits significant heterogeneity in occurrence and severity over the lifespan. Our goal is to discuss recent evidence regarding determinants of the natural history of asthma during childhood, and review the rationale behind and status of major efforts to alter its course. RECENT FINDINGS Variations in microbial exposures are associated with risk of allergic disease, and the use of bacterial lysates may be a promising preventive strategy. Exposure to air pollution appears to be particularly damaging in prenatal and early life, and interventions to reduce pollution are feasible and result in clinical benefit. E-cigarette use may have a role in harm reduction for conventional cigarette smokers with asthma, but has undefined short-term and long-term effects that must be clarified. Vitamin D insufficiency over the first several years of life is associated with risk of asthma, and vitamin D supplementation reduces the risk of severe exacerbations. SUMMARY The identification of risk factors for asthma occurrence, persistence and severity will continue to guide efforts to alter the natural history of the disease. We have reviewed several promising strategies that are currently under investigation. Vitamin D supplementation and air pollution reduction have been shown to be effective strategies and warrant increased investigation and implementation.
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Affiliation(s)
- K A Lee-Sarwar
- aDivision of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts bDivision of Pediatric Allergy, Immunology and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine cSt Louis Children's Hospital, St Louis, Missouri dChanning Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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369
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Gray LEK, O'Hely M, Ranganathan S, Sly PD, Vuillermin P. The Maternal Diet, Gut Bacteria, and Bacterial Metabolites during Pregnancy Influence Offspring Asthma. Front Immunol 2017; 8:365. [PMID: 28408909 PMCID: PMC5374203 DOI: 10.3389/fimmu.2017.00365] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/14/2017] [Indexed: 01/04/2023] Open
Abstract
This review focuses on the current evidence that maternal dietary and gut bacterial exposures during pregnancy influence the developing fetal immune system and subsequent offspring asthma. Part 1 addresses exposure to a farm environment, antibiotics, and prebiotic and probiotic supplementation that together indicate the importance of bacterial experience in immune programming and offspring asthma. Part 2 outlines proposed mechanisms to explain these associations including bacterial exposure of the fetoplacental unit; immunoglobulin-related transplacental transport of gut bacterial components; cytokine signaling producing fetomaternal immune alignment; and immune programming via metabolites produced by gut bacteria. Part 3 focuses on the interplay between diet, gut bacteria, and bacterial metabolites. Maternal diet influences fecal bacterial composition, with dietary microbiota-accessible carbohydrates (MACs) selecting short-chain fatty acid (SCFA)-producing bacteria. Current evidence from mouse models indicates an association between increased maternal dietary MACs, SCFA exposure during pregnancy, and reduced offspring asthma that is, at least in part, mediated by the induction of regulatory T lymphocytes in the fetal lung. Part 4 discusses considerations for future studies investigating maternal diet-by-microbiome determinants of offspring asthma including the challenge of measuring dietary MAC intake; limitations of the existing measures of the gut microbiome composition and metabolic activity; measures of SCFA exposure; and the complexities of childhood respiratory health assessment.
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Affiliation(s)
- Lawrence E K Gray
- Barwon Infant Study, School of Medicine, Deakin University, Geelong, VIC, Australia.,Child Health Research Unit, Barwon Health, Geelong, VIC, Australia
| | - Martin O'Hely
- Barwon Infant Study, School of Medicine, Deakin University, Geelong, VIC, Australia.,Respiratory Diseases, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Sarath Ranganathan
- Respiratory Diseases, Infection and Immunity Theme, Murdoch Children's Research Institute, Parkville, VIC, Australia.,Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Peter David Sly
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Peter Vuillermin
- Barwon Infant Study, School of Medicine, Deakin University, Geelong, VIC, Australia.,Child Health Research Unit, Barwon Health, Geelong, VIC, Australia
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370
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Tay T, Choo X, Ihsan R, Toh HP, Wong HS, Tee A. Characteristics of non-smoking adult asthma patients with chronic airflow limitation. J Asthma 2017; 54:1026-1032. [PMID: 28332897 DOI: 10.1080/02770903.2017.1299756] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Chronic airflow limitation (CAL) can develop in a subgroup of patients with asthma. Characterising these patients is important because reduced lung function is a risk factor for adverse asthma outcomes. We hypothesised that heterogeneity in patients with CAL may be influenced by age at asthma onset. We first compared never-smoking asthma patients with and without CAL, and subsequently examined the differences between patients with late and early-onset asthma within the CAL cohort. METHODS Patients seen in our hospital's respiratory clinic between 1 Jan 2015 and 31 December 2015 were recruited to the study. CAL was defined as post-bronchodilator forced expiratory volume in 1 second (FEV1)<80% predicted, in the presence of post-bronchodilator ratio <70%. Variables independently associated with CAL were determined using a multivariate logistic regression model. Comparisons between patients with late-onset asthma (age ≥18 years) and early-onset asthma were made within the CAL cohort. RESULTS 247 patients were included in the study. Age was the only variable independently associated with CAL after regression analysis, with an increase in odds of 3.8% (95% CI 0.4-7.3%) for every 1 year increase in age, p = 0.027. 63.2% of patients with CAL had late-onset asthma. Compared to patients with early-onset asthma, those with late-onset asthma had higher fractional exhaled nitric oxide levels (43 ± 32 ppb vs 20 ± 8 pb, p = 0.008). CONCLUSIONS An increase in age is associated with CAL in never-smoking asthma patients. In addition, age at asthma onset appears to influence airway inflammation in patients with CAL.
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Affiliation(s)
- TunnRen Tay
- a Department of Respiratory and Critical Care Medicine , Changi General Hospital , Singapore , Singapore
| | - Xuening Choo
- a Department of Respiratory and Critical Care Medicine , Changi General Hospital , Singapore , Singapore
| | - Rosna Ihsan
- a Department of Respiratory and Critical Care Medicine , Changi General Hospital , Singapore , Singapore
| | - Hsiao Peng Toh
- a Department of Respiratory and Critical Care Medicine , Changi General Hospital , Singapore , Singapore
| | - Hang Siang Wong
- a Department of Respiratory and Critical Care Medicine , Changi General Hospital , Singapore , Singapore
| | - Augustine Tee
- a Department of Respiratory and Critical Care Medicine , Changi General Hospital , Singapore , Singapore
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371
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Busch R, Cho MH, Silverman EK. Progress in disease progression genetics: dissecting the genetic origins of lung function decline in COPD. Thorax 2017; 72:389-390. [PMID: 28292852 DOI: 10.1136/thoraxjnl-2016-209666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Robert Busch
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael H Cho
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Edwin K Silverman
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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372
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Decline of Lung Function in Children with Sickle Cell Disease Is Not Associated with Restrictive Defects. Ann Am Thorac Soc 2017; 14:475-477. [PMID: 28248574 DOI: 10.1513/annalsats.201608-626le] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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373
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Marguet C, Petat H, Michelet I, Lubrano M, Couderc L. Synthèse N° 3 : Bronchites chroniques obstructives de l’enfant : un concept émergent. REVUE DES MALADIES RESPIRATOIRES ACTUALITES 2017; 9:73-82. [PMID: 32362958 PMCID: PMC7185827 DOI: 10.1016/s1877-1203(17)30036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- C. Marguet
- Pneumologie, allergologie & CRCM pédiatrique. Département de pédiatrie médicale, Centre hospitalier universitaire de Rouen, EA2656 université de Normandie, UNIRouen, F-7600 Rouen, France
| | - H. Petat
- Pneumologie, allergologie & CRCM pédiatrique. Département de pédiatrie médicale, Centre hospitalier universitaire de Rouen, EA2656 université de Normandie, UNIRouen, F-7600 Rouen, France
| | - I. Michelet
- Pneumologie, allergologie & CRCM pédiatrique. Département de pédiatrie médicale, Centre hospitalier universitaire de Rouen, EA2656 université de Normandie, UNIRouen, F-7600 Rouen, France
| | - M. Lubrano
- Pneumologie, allergologie & CRCM pédiatrique. Département de pédiatrie médicale, Centre hospitalier universitaire de Rouen, EA2656 université de Normandie, UNIRouen, F-7600 Rouen, France
| | - L. Couderc
- Pneumologie, allergologie & CRCM pédiatrique. Département de pédiatrie médicale, Centre hospitalier universitaire de Rouen, EA2656 université de Normandie, UNIRouen, F-7600 Rouen, France
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374
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Asthma remission: Predicting future airways responsiveness using an miRNA network. J Allergy Clin Immunol 2017; 140:598-600.e8. [PMID: 28238746 DOI: 10.1016/j.jaci.2017.01.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 01/08/2017] [Accepted: 01/25/2017] [Indexed: 12/19/2022]
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375
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Szefler SJ, Murphy K, Harper T, Boner A, Laki I, Engel M, El Azzi G, Moroni-Zentgraf P, Finnigan H, Hamelmann E. A phase III randomized controlled trial of tiotropium add-on therapy in children with severe symptomatic asthma. J Allergy Clin Immunol 2017; 140:1277-1287. [PMID: 28189771 DOI: 10.1016/j.jaci.2017.01.014] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 12/13/2016] [Accepted: 01/30/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND Studies in adults and adolescents have demonstrated that tiotropium is efficacious as an add-on therapy to inhaled corticosteroids (ICSs) with or without other maintenance therapies in patients with moderate or severe symptomatic asthma. OBJECTIVE We sought to assess the efficacy and safety of once-daily tiotropium Respimat add-on therapy to high-dose ICS with 1 or more controller medications, or medium-dose ICS with 2 or more controller medications, in the first phase III trial of tiotropium in children with severe symptomatic asthma. METHODS In this 12-week, double-blind, placebo-controlled, parallel-group trial, 401 participants aged 6 to 11 years were randomized to receive once-daily tiotropium 5 μg (2 puffs of 2.5 μg) or 2.5 μg (2 puffs of 1.25 μg), or placebo (2 puffs), administered through the Respimat device as add-on to background therapy. RESULTS Compared with placebo, tiotropium 5 μg, but not 2.5 μg, add-on therapy improved the primary end point, peak FEV1 within 3 hours after dosing (5 μg, 139 mL [95% CI, 75-203; P < .001]; 2.5 μg, 35 mL [95% CI, -28 to 99; P = .27]), and the key secondary end point, trough FEV1 (5 μg, 87 mL [95% CI, 19-154; P = .01]; 2.5 μg, 18 mL [95% CI, -48 to 85; P = .59]). The safety and tolerability of tiotropium were comparable with those of placebo. CONCLUSIONS Once-daily tiotropium Respimat 5 μg improved lung function and was well tolerated as add-on therapy to ICS with other maintenance therapies in children with severe symptomatic asthma.
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Affiliation(s)
- Stanley J Szefler
- Department of Pediatrics, Children's Hospital of Colorado and the University of Colorado School of Medicine, The Breathing Institute, Aurora, Colo.
| | - Kevin Murphy
- Boys Town National Research Hospital, Boys Town, Neb
| | | | - Attilio Boner
- U.O. di Pediatria, Dipartimento Sperimentale di Pediatria, Policlinico "G. Rossi," Verona, Italy
| | - István Laki
- Department of Paediatric Pulmonology, Törökbálint, Hungary
| | - Michael Engel
- Therapeutic Area Respiratory Diseases, Boehringer Ingelheim Pharma, Ingelheim am Rhein, Germany
| | - Georges El Azzi
- Therapeutic Area Respiratory Diseases, Boehringer Ingelheim Pharma, Ingelheim am Rhein, Germany
| | | | - Helen Finnigan
- Biostatistics and Data Sciences, Boehringer Ingelheim, Bracknell, United Kingdom
| | - Eckard Hamelmann
- Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany; Allergy Center of the Ruhr University, Bochum, Germany
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376
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Hamelmann E, Vogelberg C, Szefler SJ. Tiotropium for the treatment of asthma in adolescents. Expert Opin Pharmacother 2017; 18:305-312. [PMID: 28110558 DOI: 10.1080/14656566.2017.1285906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Asthma is a prevalent disease affecting millions of individuals. Despite receiving guideline therapy with inhaled corticosteroids (ICS) with or without a long-acting β2-agonist (LABA), a proportion of patients remain symptomatic or have suboptimal lung function. There is therefore an unmet need for additional therapies to improve asthma control. The long-acting anticholinergic tiotropium, delivered via the Respimat inhaler, is approved for the treatment of asthma in the EU, the USA, and other countries. Phase III investigation in adults has demonstrated that tiotropium improves lung function and asthma control, with a safety profile comparable with that of placebo. Areas covered: Clinical trials in adolescent patients (aged 12-17 years) with moderate or severe symptomatic asthma have shown that tiotropium Respimat as add-on to ICS, with or without other maintenance therapies, is a well-tolerated and efficacious bronchodilator showing trends toward improved asthma control, similar to data in adult patients. Expert opinion: Tiotropium Respimat may be of benefit as add-on maintenance therapy to medium- or high-dose ICS with or without LABA; however, further data are needed to directly compare the efficacy of ICS plus tiotropium versus ICS plus LABA in adolescents with symptomatic asthma, and to establish the long-term effects on airway modeling.
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Affiliation(s)
- Eckard Hamelmann
- a Klinik für Kinder- und Jugendmedizin, Kinderzentrum Bethel, Evangelisches Krankenhaus Bielefeld GmbH , Akademisches Lehrkrankenhaus der Universität Münster , Bielefeld , Germany
| | - Christian Vogelberg
- b Department of Pulmonology and Allergy , University Hospital Carl Gustav Carus, Technical University of Dresden , Dresden , Germany
| | - Stanley J Szefler
- c Pediatric Asthma Research Program, Children's Hospital Colorado, Breathing Institute , Department of Pediatrics, Section of Pulmonary Medicine , Aurora , CO , USA.,d University of Colorado School of Medicine , Aurora , CO , USA
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377
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Belgrave D, Henderson J, Simpson A, Buchan I, Bishop C, Custovic A. Disaggregating asthma: Big investigation versus big data. J Allergy Clin Immunol 2017; 139:400-407. [PMID: 27871876 PMCID: PMC5292995 DOI: 10.1016/j.jaci.2016.11.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 12/21/2022]
Abstract
We are facing a major challenge in bridging the gap between identifying subtypes of asthma to understand causal mechanisms and translating this knowledge into personalized prevention and management strategies. In recent years, "big data" has been sold as a panacea for generating hypotheses and driving new frontiers of health care; the idea that the data must and will speak for themselves is fast becoming a new dogma. One of the dangers of ready accessibility of health care data and computational tools for data analysis is that the process of data mining can become uncoupled from the scientific process of clinical interpretation, understanding the provenance of the data, and external validation. Although advances in computational methods can be valuable for using unexpected structure in data to generate hypotheses, there remains a need for testing hypotheses and interpreting results with scientific rigor. We argue for combining data- and hypothesis-driven methods in a careful synergy, and the importance of carefully characterized birth and patient cohorts with genetic, phenotypic, biological, and molecular data in this process cannot be overemphasized. The main challenge on the road ahead is to harness bigger health care data in ways that produce meaningful clinical interpretation and to translate this into better diagnoses and properly personalized prevention and treatment plans. There is a pressing need for cross-disciplinary research with an integrative approach to data science, whereby basic scientists, clinicians, data analysts, and epidemiologists work together to understand the heterogeneity of asthma.
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Affiliation(s)
| | - John Henderson
- School of Social and Community Medicine, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Angela Simpson
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Iain Buchan
- Health Informatics, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | | | - Adnan Custovic
- Department of Paediatrics, Imperial College, London, United Kingdom.
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378
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Papi A, Fabbri LM. Management of patients with early mild asthma and infrequent symptoms. Lancet 2017; 389:129-130. [PMID: 27912984 DOI: 10.1016/s0140-6736(16)32111-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 09/29/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Alberto Papi
- Research Centre on Asthma and COPD, Department of Medical Sciences, University of Ferrara, Ferrara 44121, Italy.
| | - Leonardo M Fabbri
- Department of Metabolic Medicine, University of Modena and Reggio Emilia, Sant'Agostino Estense Hospital, Modena, Italy
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379
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Jones MH, Roncada C, Fernandes MTC, Heinzmann-Filho JP, Sarria Icaza EE, Mattiello R, Pitrez PMC, Pinto LA, Stein RT. Asthma and Obesity in Children Are Independently Associated with Airway Dysanapsis. Front Pediatr 2017; 5:270. [PMID: 29326908 PMCID: PMC5741591 DOI: 10.3389/fped.2017.00270] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/04/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND An increase in the prevalence of overweight and asthma has been observed. Both conditions affect negatively lung function in adults and children. The aim of this study was to analyze the effect of overweight and asthma on lung function in children. METHODS We designed a case-control study of healthy and asthmatic subjects nested within an epidemiological asthma prevalence study in children between 8 and 16 years of age. The effect of asthma and overweight on lung function was assessed by impulse oscillometry and spirometry obtained at baseline and 10-15 min after salbutamol. RESULTS 188 children were recruited, 114 (61%) were asthmatics and 72 (38%) were overweight or obese. Children with asthma and overweight had a higher FVC (+1.16 z scores, p < 0.001) and higher FEV1 (+0.79 z scores, p = 0.004) and lower FEV1/FVC (-0.54 z scores, p = 0.008) when compared to healthy controls. Compared to normal weight asthmatics, the overweight had higher FVC (+0.78 z scores, p = 0.005) and lower FEV1/FVC (-0.50 z scores, p = 0.007). In the multivariate analysis, overweight was associated with an increase of 0.71 and 0.44 z scores in FVC and FEV1, respectively, and a reduction in FEV1/FVC by 0.40 z scores (p < 0.01 for all). Overweight had no effect on maximal flows and airway resistance at baseline, and this was not modified by inhalation of a bronchodilator. Asthma was also associated with higher post-BD FVC (0.45 z scores, p = 0.012) and FEV1 (0.35 z scores, p = 0.034) but not with FEV1/FVC and FEF25-75%. Two-way analysis of variance did not detect any interaction between asthma and overweight on lung function variables before or after bronchodilator. CONCLUSION Our results suggest that asthma and overweight are independently associated with airway dysanaptic growth in children which can be further scrutinized using impulse oscillometry. Overweight contributed more to the reduction in FEV1/FVC than asthma in children without increasing airway resistance. Spirometry specificity and sensitivity for obstructive diseases may be reduced in populations with high prevalence of overweight. Adding impedance oscillometry to spirometry improves our understanding of the ventilatory abnormalities in overweight children.
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Affiliation(s)
- Marcus H Jones
- Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Cristian Roncada
- Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Morgana Thais Carollo Fernandes
- Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,School of Nursing, Centro Universitário Ritter dos Reis, Porto Alegre, Brazil
| | - João Paulo Heinzmann-Filho
- Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | | | - Rita Mattiello
- Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Paulo Marcio C Pitrez
- Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Leonardo A Pinto
- Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Renato T Stein
- Laboratory of Respiratory Physiology, Infant Center, School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
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380
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Add-on effect of Yu Ping Feng formula for childhood asthma: A meta-analysis of randomized controlled trials. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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381
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McGeachie MJ, Yates KP, Zhou X, Guo F, Sternberg AL, Van Natta ML, Wise RA, Szefler SJ, Sharma S, Kho AT, Cho MH, Croteau-Chonka DC, Castaldi PJ, Jain G, Sanyal A, Zhan Y, Lajoie BR, Dekker J, Stamatoyannopoulos J, Covar RA, Zeiger RS, Adkinson NF, Williams PV, Kelly HW, Grasemann H, Vonk JM, Koppelman GH, Postma DS, Raby BA, Houston I, Lu Q, Fuhlbrigge AL, Tantisira KG, Silverman EK, Tonascia J, Strunk RC, Weiss ST. Genetics and Genomics of Longitudinal Lung Function Patterns in Individuals with Asthma. Am J Respir Crit Care Med 2016; 194:1465-1474. [PMID: 27367781 PMCID: PMC5215031 DOI: 10.1164/rccm.201602-0250oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 06/30/2016] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Patterns of longitudinal lung function growth and decline in childhood asthma have been shown to be important in determining risk for future respiratory ailments including chronic airway obstruction and chronic obstructive pulmonary disease. OBJECTIVES To determine the genetic underpinnings of lung function patterns in subjects with childhood asthma. METHODS We performed a genome-wide association study of 581 non-Hispanic white individuals with asthma that were previously classified by patterns of lung function growth and decline (normal growth, normal growth with early decline, reduced growth, and reduced growth with early decline). The strongest association was also measured in two additional cohorts: a small asthma cohort and a large chronic obstructive pulmonary disease metaanalysis cohort. Interaction between the genomic region encompassing the most strongly associated single-nucleotide polymorphism and nearby genes was assessed by two chromosome conformation capture assays. MEASUREMENTS AND MAIN RESULTS An intergenic single-nucleotide polymorphism (rs4445257) on chromosome 8 was strongly associated with the normal growth with early decline pattern compared with all other pattern groups (P = 6.7 × 10-9; odds ratio, 2.8; 95% confidence interval, 2.0-4.0); replication analysis suggested this variant had opposite effects in normal growth with early decline and reduced growth with early decline pattern groups. Chromosome conformation capture experiments indicated a chromatin interaction between rs4445257 and the promoter of the distal CSMD3 gene. CONCLUSIONS Early decline in lung function after normal growth is associated with a genetic polymorphism that may also protect against early decline in reduced growth groups. Clinical trial registered with www.clinicaltrials.gov (NCT00000575).
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Affiliation(s)
- Michael J. McGeachie
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Xiaobo Zhou
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Feng Guo
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Robert A. Wise
- School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Stanley J. Szefler
- National Jewish Health and Research Center, Denver, Colorado
- Children's Hospital Colorado and
| | - Sunita Sharma
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Denver, Colorado
| | - Alvin T. Kho
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Boston Children’s Hospital, Boston, Massachusetts
| | - Michael H. Cho
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Damien C. Croteau-Chonka
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Peter J. Castaldi
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gaurav Jain
- Program in Systems Biology, Department of Biochemistry and Molecular Pharmacology, and
| | - Amartya Sanyal
- Program in Systems Biology, Department of Biochemistry and Molecular Pharmacology, and
- School of Biological Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Ye Zhan
- Program in Systems Biology, Department of Biochemistry and Molecular Pharmacology, and
| | - Bryan R. Lajoie
- Program in Systems Biology, Department of Biochemistry and Molecular Pharmacology, and
| | - Job Dekker
- Howard Hughes Medical Institute, Program in Systems Biology, Department of Biochemistry and Molecular Pharmacology, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Ronina A. Covar
- National Jewish Health and Research Center, Denver, Colorado
- Children's Hospital Colorado and
- University of Colorado, Denver, Colorado
| | - Robert S. Zeiger
- Department of Pediatrics, University of California at San Diego, La Jolla, California
- Kaiser Permanente Southern California Region, San Diego, California
| | | | - Paul V. Williams
- ASTHMA, Inc., Clinical Research Center and Northwest Asthma & Allergy Center, Seattle, Washington
| | - H. William Kelly
- University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Hartmut Grasemann
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | | | - Gerard H. Koppelman
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children’s Hospital, and
| | - Dirkje S. Postma
- Department of Pulmonology, University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD, Groningen, the Netherlands
| | - Benjamin A. Raby
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Isaac Houston
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Quan Lu
- Program in Molecular and Integrative Physiological Sciences, Departments of Environmental Health and Genetics & Complex Diseases, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; and
| | - Anne L. Fuhlbrigge
- Channing Division of Network Medicine and
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kelan G. Tantisira
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Edwin K. Silverman
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Robert C. Strunk
- Division of Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Scott T. Weiss
- Channing Division of Network Medicine and
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
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382
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McGeachie MJ, Clemmer GL, Croteau-Chonka DC, Castaldi PJ, Cho MH, Sordillo JE, Lasky-Su JA, Raby BA, Tantisira KG, Weiss ST. Whole genome prediction and heritability of childhood asthma phenotypes. IMMUNITY INFLAMMATION AND DISEASE 2016; 4:487-496. [PMID: 27980782 PMCID: PMC5134727 DOI: 10.1002/iid3.133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/01/2016] [Accepted: 09/04/2016] [Indexed: 01/19/2023]
Abstract
Introduction While whole genome prediction (WGP) methods have recently demonstrated successes in the prediction of complex genetic diseases, they have not yet been applied to asthma and related phenotypes. Longitudinal patterns of lung function differ between asthmatics, but these phenotypes have not been assessed for heritability or predictive ability. Herein, we assess the heritability and genetic predictability of asthma‐related phenotypes. Methods We applied several WGP methods to a well‐phenotyped cohort of 832 children with mild‐to‐moderate asthma from CAMP. We assessed narrow‐sense heritability and predictability for airway hyperresponsiveness, serum immunoglobulin E, blood eosinophil count, pre‐ and post‐bronchodilator forced expiratory volume in 1 sec (FEV1), bronchodilator response, steroid responsiveness, and longitudinal patterns of lung function (normal growth, reduced growth, early decline, and their combinations). Prediction accuracy was evaluated using a training/testing set split of the cohort. Results We found that longitudinal lung function phenotypes demonstrated significant narrow‐sense heritability (reduced growth, 95%; normal growth with early decline, 55%). These same phenotypes also showed significant polygenic prediction (areas under the curve [AUCs] 56% to 62%). Including additional demographic covariates in the models increased prediction 4–8%, with reduced growth increasing from 62% to 66% AUC. We found that prediction with a genomic relatedness matrix was improved by filtering available SNPs based on chromatin evidence, and this result extended across cohorts. Conclusions Longitudinal reduced lung function growth displayed extremely high heritability. All phenotypes with significant heritability showed significant polygenic prediction. Using SNP‐prioritization increased prediction across cohorts. WGP methods show promise in predicting asthma‐related heritable traits.
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Affiliation(s)
- Michael J McGeachie
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - George L Clemmer
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Damien C Croteau-Chonka
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Peter J Castaldi
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Michael H Cho
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Joanne E Sordillo
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Jessica A Lasky-Su
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Benjamin A Raby
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Kelan G Tantisira
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Scott T Weiss
- Channing Division of Network Medicine Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts
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383
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Sood S, Castro M. Asthma in 2016: reassured about the old, excited about the new. THE LANCET RESPIRATORY MEDICINE 2016; 4:937-939. [PMID: 27890498 DOI: 10.1016/s2213-2600(16)30380-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Shweta Sood
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Mario Castro
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Washington University School of Medicine, St Louis, MO, USA.
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384
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Abrams EM, Szefler SJ, Becker AB. Effect of asthma therapies on the natural course of asthma. Ann Allergy Asthma Immunol 2016; 117:627-633. [PMID: 28073701 DOI: 10.1016/j.anai.2016.09.438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 09/19/2016] [Accepted: 09/23/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To provide an evidence-based review on the role of pharmacologic (inhaled corticosteroids, leukotriene receptor antagonists, biologic therapies, aeroallergen immunotherapy) and nonpharmacologic therapies (environmental modifications, microbiome) in secondary and tertiary asthma prevention. DATA SOURCES A PubMed search for English-language publications regarding asthma and secondary or tertiary prevention was performed. Some articles cited in selected studies were also considered for inclusion in this review. STUDY SELECTIONS Studies were included that were original research and specifically addressed the question of asthma prevention and use of pharmacologic or nonpharmacologic therapies. When possible, we selected the articles with the most robust level of evidence. RESULTS More than 100 articles were initially identified, 79 were reviewed in depth, and 60 were included in this review. Several studies suggest no disease-modifying effect for inhaled corticosteroids. Small studies suggest a tertiary preventive effect for leukotriene receptor antagonists. Biological therapies have somewhat conflicting evidence with a paucity of pediatric data, although some have tremendous promise. A role of allergen immunotherapy (specifically pollen) in secondary asthma prevention has been suggested, with no firm conclusions possible for tertiary prevention. One large trial suggests a role for environmental modifications in secondary asthma prevention, whereas the preponderance of evidence does not suggest a role in tertiary prevention. The microbiome is an active area of research that has promise for a disease-modifying effect. CONCLUSION Further work needs to be performed to allow physicians to intervene early and alter the natural course of asthma in children.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Stanley J Szefler
- Department of Pediatrics, Section of Pulmonology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Allan B Becker
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
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385
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Brouwer ML, Wijngaart LSVD, Hugen CAC, Gerrits GPJM, Roukema J, Merkus PJFM. Evaluation of monitoring strategies for childhood asthma. Expert Rev Respir Med 2016; 10:1199-1209. [PMID: 27666112 DOI: 10.1080/17476348.2016.1240034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION The goal of monitoring pediatric asthma is to obtain and maintain asthma control, which is defined as minimizing asthma symptoms, restrictions to daily activities and the use of rescue medication. Long term goals include reducing the risk of fixed airflow limitation, and preventing asthma exacerbations and side effects of treatment. Several monitoring tools are available but no consensus exists on how to monitor patients in the most optimal way. Areas covered: In this review, we provide an overview of different tools and address general considerations on monitoring childhood asthma. Asthma care should be tailored to the individual patient. The health care professional should decide which monitoring strategy and frequency is optimal for the individual patient. Expert commentary: Personalized medicine should be the key issue in monitoring asthma in children. It is crucial to monitor disease activity and deterioration but there is no monitoring strategy that is clearly superior compared to others: The optimal strategy and frequency will vary between patients. Actually, both treatment and monitoring of pediatric asthma probably benefit from a personalized approach.
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Affiliation(s)
- M L Brouwer
- a Department of pediatrics , Canisius Wilhelmina Hospital , Nijmegen , The Netherlands
| | - L S van den Wijngaart
- b Amalia children's hospital, department of pediatrics, division of respiratory medicine , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - C A C Hugen
- c Department of pediatrics , University Centre for Chronic Diseases (Dekkerswald) , Nijmegen , The Netherlands
| | - G P J M Gerrits
- a Department of pediatrics , Canisius Wilhelmina Hospital , Nijmegen , The Netherlands
| | - J Roukema
- b Amalia children's hospital, department of pediatrics, division of respiratory medicine , Radboud University Medical Centre , Nijmegen , The Netherlands
| | - P J F M Merkus
- a Department of pediatrics , Canisius Wilhelmina Hospital , Nijmegen , The Netherlands.,b Amalia children's hospital, department of pediatrics, division of respiratory medicine , Radboud University Medical Centre , Nijmegen , The Netherlands
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386
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Fuchs O, Bahmer T, Rabe KF, von Mutius E. Asthma transition from childhood into adulthood. THE LANCET RESPIRATORY MEDICINE 2016; 5:224-234. [PMID: 27666650 DOI: 10.1016/s2213-2600(16)30187-4] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 06/13/2016] [Accepted: 06/23/2016] [Indexed: 12/11/2022]
Abstract
Asthma is the most prevalent chronic respiratory disease both in children and adults and resembles a complex syndrome rather than a single disease. Different methods have been developed to better characterise distinct asthma phenotypes in childhood and adulthood. In studies of adults, most phenotyping relies on biomaterials from the lower airways; however, this information is missing in paediatric studies because of restricted accessibility. Few patients show symptoms throughout childhood, adolescence, and adulthood. Risk factors for this might be genetics, family history of asthma and atopy, infections early in life, allergic diseases, and lung function deficits. In turn, a large proportion of children with asthma lose their symptoms during school age and adolescence. This improved prognosis, which might also reflect a better treatment response, is associated with being male and with milder and less allergic disease. Importantly, whether clinical remission of symptoms equals the disappearance of underlying pathology is unknown. In fact, airway hyper-responsiveness and airway inflammation might remain despite the absence of overt symptoms. Additionally, a new-onset of asthma symptoms is apparent in adulthood, especially in women and in the case of impaired lung function. However, many patients do not remember childhood symptoms, which might reflect relapse rather than true initiation. Both relapse and adult-onset of asthma symptoms have been associated with allergic disease and sensitisation in addition to airway hyper-responsiveness. Thus, asthma symptoms beginning in adults might have originated in childhood. Equivocally, persistence into, relapse, and new-onset of symptoms in adulthood have all been related to active smoking. However, underlying mechanisms for the associations remain unclear, and future asthma research should therefore integrate standardised molecular approaches in identical ways in both paediatric and adult populations and in longitudinal studies.
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Affiliation(s)
- Oliver Fuchs
- Division of Paediatric Allergology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Comprehensive Pneumology Centre Munich (CPC-M), Munich, Germany; German Centre for Lung Research (DZL).
| | - Thomas Bahmer
- LungenClinic Grosshansdorf, Grosshansdorf, Germany; Airway Research Centre North (ARCN), Lubeck, Germany; ARCN, Kiel, Germany; ARCN, Grosshansdorf, Germany; German Centre for Lung Research (DZL)
| | - Klaus F Rabe
- LungenClinic Grosshansdorf, Grosshansdorf, Germany; Department of Medicine, Christian-Albrechts-University, Kiel, Germany; Airway Research Centre North (ARCN), Lubeck, Germany; ARCN, Kiel, Germany; ARCN, Grosshansdorf, Germany; German Centre for Lung Research (DZL)
| | - Erika von Mutius
- Division of Paediatric Allergology, Dr von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany; Comprehensive Pneumology Centre Munich (CPC-M), Munich, Germany; German Centre for Lung Research (DZL)
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387
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Deshpande D, Morgan W. Wheezing disorders in children: Are girls and boys different? J Allergy Clin Immunol 2016; 138:1569-1570. [PMID: 27637384 DOI: 10.1016/j.jaci.2016.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 07/19/2016] [Indexed: 12/20/2022]
Affiliation(s)
| | - Wayne Morgan
- Department of Pediatrics, University of Arizona, Tucson, Ariz; Asthma and Airway Disease Research Center, University of Arizona, Tucson, Ariz
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Crouch DR, Akuthota P. Asthma at the 2016 American Thoracic Society International Conference. J Thorac Dis 2016; 8:S556-8. [PMID: 27606093 DOI: 10.21037/jtd.2016.07.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Daniel R Crouch
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Praveen Akuthota
- Division of Pulmonary, Critical Care & Sleep Medicine, Department of Medicine, University of California San Diego, San Diego, CA, USA
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389
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Affiliation(s)
- Fernando D Martinez
- From the Asthma and Airway Disease Research Center, University of Arizona, Tucson
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Abstract
This review highlights the important articles published in the area of asthma research from January 2015 to July 2016. In basic science, significant advances have been made in understanding the link between the innate immune response and type II acquired immune responses in asthma and the role of the airway epithelium. Novel information continues to emerge with regard to the pathogenesis and heterogeneity of severe asthma. There have been important translational clinical trials in the areas of childhood asthma, treatment of allergy to improve asthma outcomes, and improving drug delivery to optimize the management of asthma. In addition, there are increasing data concerning the application of biological agents to the management of severe asthma. This body of work discusses the most notable advances in the understanding and management of asthma.
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Affiliation(s)
- Su-Ling Loo
- Priority Research Centre for Healthy Lungs, University of Newcastle, Hunter Medical Research Institute, New Lambton, NSW, 2305, Australia
| | - Peter A B Wark
- Priority Research Centre for Healthy Lungs, University of Newcastle, Hunter Medical Research Institute, New Lambton, NSW, 2305, Australia
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Reinhardt D. [Not Available]. MMW Fortschr Med 2016; 158:37. [PMID: 27525779 DOI: 10.1007/s15006-016-8578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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