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Seddon PC, Willson R, Olden C, Symes E, Lombardi E, Beydon N. Bronchodilator response by interrupter technique to guide management of preschool wheeze. Arch Dis Child 2023; 108:768-773. [PMID: 37258055 DOI: 10.1136/archdischild-2022-324496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVE We examined relationships between clinical features and pulmonary function before and after inhaled corticosteroid (ICS) treatment in wheezy preschool children, and specifically, whether measuring bronchodilator response (BDR) could predict benefit from ICS. DESIGN Clinical non-randomised intervention study SETTING: Secondary care. PATIENTS Preschool children (2 years to <6 years) with recurrent wheeze. INTERVENTIONS Inhaled beta-agonist, ICS. OUTCOME MEASURES We measured prebronchodilator and postbronchodilator interrupter resistance (Rint) and symptom scores at 0 (V1), 4 (V2) and 12 (V3) weeks. At V2, those with a predetermined symptom level commenced ICS. Modified Asthma Predictive Index (mAPI) and parental perception of response to bronchodilator were recorded. Response to ICS was defined as a reduction in daily symptom score of >0.26. Positive BDR was defined as fall in Rint of ≥0.26 kPa.s/L, ≥35% predicted or ≥1.25 Z Scores. RESULTS Out of 138 recruited children, 67 completed the full study. Mean (SD) prebronchodilator Rint at V2 was 1.22 (0.35) kPa.s/L, and fell after starting ICS (V3) to 1.09 (0.33) kPa.s/L (p<0.001), while mean (SD) daily symptom score fell from 0.56 (0.36) to 0.28 (0.36) after ICS (p<0.001). Positive Rint BDR before ICS (at V1 and/or V2), using all three threshold criteria, was significantly associated with response to ICS on symptom scores at V3 (p<0.05). mAPI was not significantly associated with response to ICS, and parents' perception of response to bronchodilator was not related to measured Rint BDR . CONCLUSIONS Rint BDR may be helpful in selecting which wheezy preschool children are likely to benefit from ICS.
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Affiliation(s)
- Paul C Seddon
- Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Rhian Willson
- Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Catherine Olden
- Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Elizabeth Symes
- Respiratory Care, Royal Alexandra Children's Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
| | - Enrico Lombardi
- Paediatric Pulmonary Unit, Ospedale Pediatrico Meyer, Firenze, Toscana, Italy
| | - Nicole Beydon
- Unité Fonctionnelle de Physiologie Explorations Fonctionnelles Respiratoires, Armand-Trousseau Childrens' Hospital, Paris, Île-de-France, France
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2
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Chowdhury NU, Guntur VP, Newcomb DC, Wechsler ME. Sex and gender in asthma. Eur Respir Rev 2021; 30:30/162/210067. [PMID: 34789462 DOI: 10.1183/16000617.0067-2021] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/26/2021] [Indexed: 12/16/2022] Open
Abstract
Asthma is a heterogenous disease, and its prevalence and severity are different in males versus females through various ages. As children, boys have an increased prevalence of asthma. As adults, women have an increased prevalence and severity of asthma. Sex hormones, genetic and epigenetic variations, social and environmental factors, and responses to asthma therapeutics are important factors in the sex differences observed in asthma incidence, prevalence and severity. For women, fluctuations in sex hormone levels during puberty, the menstrual cycle and pregnancy are associated with asthma pathogenesis. Further, sex differences in gene expression and epigenetic modifications and responses to environmental factors, including SARS-CoV-2 infections, are associated with differences in asthma incidence, prevalence and symptoms. We review the role of sex hormones, genetics and epigenetics, and their interactions with the environment in the clinical manifestations and therapeutic response of asthma.
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Affiliation(s)
- Nowrin U Chowdhury
- Dept of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.,The NJH Cohen Family Asthma Institute, Denver, CO, USA.,Equal contribution to first authorship
| | - Vamsi P Guntur
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, USA.,The NJH Cohen Family Asthma Institute, Denver, CO, USA.,Equal contribution to first authorship
| | - Dawn C Newcomb
- Dept of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA .,Dept of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael E Wechsler
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, USA.,The NJH Cohen Family Asthma Institute, Denver, CO, USA
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3
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Hao H, Bao W, Xue Y, Zhou Y, Huang Z, Yin D, Zhang Y, Zhang P, Lv C, Han L, Zhou X, Yin J, Zhang M. Spirometric Changes in Bronchodilation Tests as Predictors of Asthma Diagnosis and Treatment Response in Patients with FEV 1 ≥ 80% Predicted. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3098-3108.e4. [PMID: 33766580 DOI: 10.1016/j.jaip.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/01/2021] [Accepted: 03/02/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Many patients with mild asthma are undiagnosed and untreated due to the low diagnostic sensitivity of bronchodilation test (BDT). OBJECTIVE To investigate whether airway reversibility in BDT and fractional exhaled nitric oxide (Feno) can predict the response to antiasthma therapy (RAT) in patients with suspected asthma. METHODS This open-label, prospective cohort study included patients with chronic recurrent asthma symptoms, normal FEV1, and negative BDT results. Inhaled corticosteroids and long-acting β agonists were given for 4 weeks. A positive RAT was defined as improved symptoms and an increase of more than 200 mL in FEV1 after inhaled corticosteroid/long-acting β agonist treatment. Lung tissues from another 19 patients who underwent pneumectomy for lung nodules were also analyzed. RESULTS Of 110 patients recruited, 102 completed the study. Patients in the positive RAT group had a higher Feno and greater absolute (Δ) and percent (Δ%) improvements in forced vital capacity, FEV1, and forced expiratory flows (FEFs) in BDT than in the negative RAT group. The area under the curves of Feno, ΔFEV1%, ΔFEF25-75% (percent improvement in FEF at 25%-75% of forced vital capacity), and ΔFEF75% (percent improvement in FEF at 75% of forced vital capacity) for positive RAT were 0.703, 0.824, 0.736, and 0.710, with cutoff values of 33 parts per billion and 3.50%, 15.26%, and 26.04%, respectively. A joint model of Feno and ΔFEV1% increased the area under the curve to 0.880. Inflammatory cytokines were higher in the lung tissues of patients with predicted positive RAT than in those with predicted negative RAT. CONCLUSIONS ΔFEV1% in BDT together with Feno predicted a positive RAT and an asthma diagnosis in patients with a normal FEV1 and negative BDT. Evidence of pathological changes increases the credibility of the predictive model.
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Affiliation(s)
- Huijuan Hao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Wuping Bao
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yishu Xue
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhou
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhixuan Huang
- School of Mathematical Sciences, Tongji University, Shanghai, China
| | - Dongning Yin
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yingying Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Pengyu Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Chengjian Lv
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Han
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Zhou
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Junfeng Yin
- School of Mathematical Sciences, Tongji University, Shanghai, China
| | - Min Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China.
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4
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Asthma-Like Features and Anti-Asthmatic Drug Prescription in Children with Non-CF Bronchiectasis. J Clin Med 2020; 9:jcm9124009. [PMID: 33322440 PMCID: PMC7764222 DOI: 10.3390/jcm9124009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/03/2020] [Accepted: 12/08/2020] [Indexed: 12/28/2022] Open
Abstract
Bronchiectasis and asthma may share some characteristics and some patients may have both conditions. The present study aimed to examine the rationale of prophylactic inhaled corticosteroids (ICS) prescription in children with bronchiectasis. Data of children with radiologically established bronchiectasis were retrospectively reviewed. Episodes of dyspnea and wheezing, spirometric indices, total serum IgE, blood eosinophil counts, sensitization to aeroallergens, and air-trapping on expiratory CT scans, were recorded. The study included 65 children 1.5–16 years old, with non-CF bronchiectasis. Episodes of dyspnea or wheezing were reported by 22 (33.8%) and 23 (35.4%), respectively. Skin prick tests to aeroallergens (SPTs) were positive in 15 (23.0%) patients. Mosaic pattern on CT scans was observed in 37 (56.9%) patients. Dyspnea, presence of mosaic pattern, positive reversibility test, and positive SPTs were significantly correlated with the prescription of ICS. The prescription of ICS in children with bronchiectasis is more likely when there are certain asthma-like characteristics. The difficulty to set the diagnosis of real asthma in cases of bronchiectasis may justify the decision of clinicians to start an empirical trial with ICS in certain cases.
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5
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Baer B, McCaig L, Yamashita C, Veldhuizen R. Exogenous Surfactant as a Pulmonary Delivery Vehicle for Budesonide In Vivo. Lung 2020; 198:909-916. [PMID: 33106891 PMCID: PMC7587541 DOI: 10.1007/s00408-020-00399-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/14/2020] [Indexed: 12/19/2022]
Abstract
Background Lung inflammation is associated with many respiratory conditions. Consequently, anti-inflammatory medications, like glucocorticoids, have become mainstay intrapulmonary therapeutics. However, their effectiveness for treating inflammation occurring in the alveolar regions of the lung is limited by suboptimal delivery. To improve the pulmonary distribution of glucocorticoids, such as budesonide to distal regions of the lung, exogenous surfactant has been proposed as an ideal delivery vehicle for such therapies. It was therefore hypothesized that fortifying an exogenous surfactant (BLES) with budesonide would enhance efficacy for treating pulmonary inflammation in vivo. Methods An intratracheal instillation of heat-killed bacteria was used to elicit an inflammatory response in the lungs of male and female rats. Thirty minutes after this initial instillation, either budesonide or BLES combined with budesonide was administered intratracheally. To evaluate the efficacy of surfactant delivery, various markers of inflammation were measured in the bronchoalveolar lavage and lung tissue. Results Although budesonide exhibited anti-inflammatory effects when administered alone, delivery with BLES enhanced those effects by lowering the lavage neutrophil counts and myeloperoxidase activity in lung tissue. Combining budesonide with BLES was also shown to reduce several other pro-inflammatory mediators. These results were shown across both sexes, with no observed sex differences. Conclusion Based on these findings, it was concluded that exogenous surfactant can enhance the delivery and efficacy of budesonide in vivo.
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Affiliation(s)
- Brandon Baer
- Department of Physiology and Pharmacology, Western University, London, ON, Canada.
| | - Lynda McCaig
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
| | - Cory Yamashita
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
| | - Ruud Veldhuizen
- Department of Physiology and Pharmacology, Western University, London, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
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Ramadan AA, Gaffin JM, Israel E, Phipatanakul W. Asthma and Corticosteroid Responses in Childhood and Adult Asthma. Clin Chest Med 2020; 40:163-177. [PMID: 30691710 DOI: 10.1016/j.ccm.2018.10.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Corticosteroids are the most effective treatment for asthma; inhaled corticosteroids (ICSs) are the first-line treatment for children and adults with persistent symptoms. ICSs are associated with significant improvements in lung function. The anti-inflammatory effects of corticosteroids are mediated by both genomic and nongenomic factors. Variation in the response to corticosteroids has been observed. Patient characteristics, biomarkers, and genetic features may be used to predict response to ICSs. The existence of multiple mechanisms underlying glucocorticoid insensitivity raises the possibility that this might indeed reflect different diseases with a common phenotype.
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Affiliation(s)
- Amira Ali Ramadan
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Beth Israel Deaconess Center, Cardiovascular institute, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Jonathan M Gaffin
- Division of Respiratory Diseases, Boston Children's Hospital, Boston, MA, USA
| | - Elliot Israel
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA; Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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7
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Lang JE, Bunnell HT, Lima JJ, Hossain MJ, Wysocki T, Bacharier L, Dempsey A, Ulrich L, Test MR, Forrest CB. Effects of age, sex, race/ethnicity, and allergy status in obesity-related pediatric asthma. Pediatr Pulmonol 2019; 54:1684-1693. [PMID: 31469258 DOI: 10.1002/ppul.24470] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/12/2019] [Indexed: 11/08/2022]
Abstract
RATIONALE Obesity in children increases the risk for new asthma. How age, sex, race/ethnicity, and allergy status affect the relationship between obesity and asthma is unclear. This study describes the relationship between high body mass index (BMI) and incident asthma. METHODS We conducted a retrospective cohort study to compare asthma incidence among normal weight, overweight, and obese 2 to 6, 7 to 11, and 12 to 17 year olds to define the effects of sex, race/ethnicity, and allergy status. Weight status was determined at baseline and asthma incidence was defined as ≥2 asthma encounters and ≥1 asthma prescriptions. We used multivariable Poisson regression to estimate adjusted incident asthma rates and risk ratios. RESULTS Data from 192 843 2 to 6 year olds, 157 284 7 to 11 year olds, and 157 369 12 to 17 year olds were included. The relative risks (95% confidence interval [CI]) of new asthma among obese children in 2 to 6 year olds, 7 to 11 year olds, and 12 to 17 year olds were 1.25 (1.15, 1.37), 1.49 (1.32, 1.69) and 1.40 (1.21, 1.63), respectively. Among children with underlying allergic rhinitis, obesity did not increase the risk of new asthma. In children without allergic rhinitis, the risk for obesity-related asthma was highest in 7 to 11 year olds (risk ratio = 1.50 95% CI, 1.33, 1.60). Before age 12, females had a higher risk for obesity-related asthma; but after age 12, obese males had a higher asthma risk (interaction P-value < .05). CONCLUSION Obesity is a major preventable risk factor for pediatric asthma that appears to vary along the pediatric age continuum and depends on sex, race/ethnicity and atopy status.
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Affiliation(s)
- Jason E Lang
- Division of Allergy/Immunology and Pulmonary Medicine, Duke University School of Medicine, Duke Children's Hospital and Health Center, Durham, North Carolina
| | - H Timothy Bunnell
- Department of Biomedical Research, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - John J Lima
- Center for Pharmacogenomics and Translational Research, Nemours Children's Health System, Jacksonville, Florida
| | - Md Jobayer Hossain
- Department of Biomedical Research, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Tim Wysocki
- Nemours Children's Health System, Jacksonville, Florida
| | - Leonard Bacharier
- Department of Pediatrics, Washington University, St. Louis, Missouri
| | - Amanda Dempsey
- Department of Pediatrics, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Lisa Ulrich
- Section of Pulmonary Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Matthew R Test
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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8
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McLaughlin AV, Bhandari A, Schramm CM. Two vs four puffs of albuterol: does dose change bronchodilator response? J Asthma Allergy 2019; 12:59-65. [PMID: 30774391 PMCID: PMC6362946 DOI: 10.2147/jaa.s151531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Reversible obstruction on spirometry may be used to diagnose asthma. As per 2005 American Thoracic Society (ATS) guidelines, our pulmonary center began using 360 µg (four puffs) of albuterol rather than 180 µg (two puffs) to determine reversibility on spirometry starting in 2009. Hypothesis We hypothesized that fewer patients would respond to two puffs of albuterol than four puffs during spirometric testing. Methods We retrospectively reviewed records from new asthmatics seen in Pediatric Pulmonary Clinic from March 2002 to April 2014 who performed reproducible spirometry. Patients were divided into two groups based on whether they had received two or four puffs of albuterol for bronchodilator assessment. A positive bronchodilator response was defined as an increase of ≥12% in forced expiratory volume in one second (FEV1) or ≥25% in forced expiratory flow (FEF25–75%). Data were expressed as percentages and mean ± standard error of the mean values. Chi-squared test and Student’s t-test were utilized. Results Data were collected for 240 patients; 115 patients received two puffs of albuterol and 125 patients received four puffs. There were no significant differences in baseline characteristics between the two groups. There were no differences following two puffs or four puffs in changes in FEV1 (10.0±1.1% vs 10.5±1.1% predicted) or FEF25–75% (30.2±2.9% vs 33.5±2.9% predicted). Moreover, there was no difference in ATS-defined bronchodilator response between the two groups. Conclusion Based on the mean change in FEV1 and overall bronchodilator responsiveness, two puffs of albuterol were not inferior to four puffs in the determination of bronchodilator responsiveness in our pediatric asthmatic patients.
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Affiliation(s)
- Anne V McLaughlin
- Department of Pediatric Pulmonary Medicine, Connecticut Children's Medical Center, Hartford, CT, USA, .,Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA,
| | - Anita Bhandari
- Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Craig M Schramm
- Department of Pediatric Pulmonary Medicine, Connecticut Children's Medical Center, Hartford, CT, USA, .,Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA,
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Lang JE, Bunnell HT, Hossain MJ, Wysocki T, Lima JJ, Finkel TH, Bacharier L, Dempsey A, Sarzynski L, Test M, Forrest CB. Being Overweight or Obese and the Development of Asthma. Pediatrics 2018; 142:peds.2018-2119. [PMID: 30478238 DOI: 10.1542/peds.2018-2119] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Adult obesity is linked to asthma cases and is estimated to lead to 250 000 new cases yearly. Similar incidence and attributable risk (AR) estimates have not been developed for children. We sought to describe the relationship between overweight and obesity and incident asthma in childhood and quantify AR statistics in the United States for overweight and obesity on pediatric asthma. METHODS The PEDSnet clinical data research network was used to conduct a retrospective cohort study (January 2009-December 2015) to compare asthma incidence among overweight and/or obese versus healthy weight 2- to 17-year-old children. Asthma incidence was defined as ≥2 encounters with a diagnosis of asthma and ≥1 asthma controller prescription. Stricter diagnostic criteria involved confirmation by spirometry. We used multivariable Poisson regression analyses to estimate incident asthma rates and risk ratios and accepted formulas for ARs. RESULTS Data from 507 496 children and 19 581 972 encounters were included. The mean participant observation period was 4 years. The adjusted risk for incident asthma was increased among children who were overweight (relative risk [RR]: 1.17; 95% confidence interval [CI]: 1.10-1.25) and obese (RR: 1.26; 95% CI: 1.18-1.34). The adjusted risk for spirometry-confirmed asthma was increased among children with obesity (RR: 1.29; 95% CI: 1.16-1.42). An estimated 23% to 27% of new asthma cases in children with obesity is directly attributable to obesity. In the absence of overweight and obesity, 10% of all cases of asthma would be avoided. CONCLUSIONS Obesity is a major preventable risk factor for pediatric asthma.
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Affiliation(s)
- Jason E Lang
- Nemours Children's Hospital, Nemours Children's Health System, Orlando, Florida; .,Divisions of Allergy and Immunology and.,Pulmonary Medicine, School of Medicine, Duke University and Duke Children's Hospital and Health Center, Durham, North Carolina
| | - H Timothy Bunnell
- Department of Biomedical Research, Nemours Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Md Jobayer Hossain
- Department of Biomedical Research, Nemours Alfred I. DuPont Hospital for Children, Wilmington, Delaware
| | - Tim Wysocki
- Centers for Health Care Delivery Science and
| | - John J Lima
- Pharmacogenomics and Translational Research, Nemours Children's Health System, Jacksonville, Florida
| | - Terri H Finkel
- Nemours Children's Hospital, Nemours Children's Health System, Orlando, Florida
| | | | - Amanda Dempsey
- Department of Pediatrics, School of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Lisa Sarzynski
- Section of Pulmonary Medicine, Nationwide Children's Hospital and Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Matthew Test
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington; and
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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10
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Wu YF, Su MW, Chiang BL, Yang YH, Tsai CH, Lee YL. A simple prediction tool for inhaled corticosteroid response in asthmatic children. BMC Pulm Med 2017; 17:176. [PMID: 29216859 PMCID: PMC5721661 DOI: 10.1186/s12890-017-0533-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 11/29/2017] [Indexed: 01/05/2023] Open
Abstract
Background Inhaled corticosteroids are recommended as the first-line controller medication for childhood asthma owing to their multiple clinical benefits. However, heterogeneity in the response towards these drugs remains a significant clinical problem. Methods Children aged 5 to 18 years with mild to moderate persistent asthma were recruited into the Taiwanese Consortium of Childhood Asthma Study. Their responses to inhaled corticosteroids were assessed based on their improvements in the asthma control test and peak expiratory flow. The predictors of responsiveness were demographic and clinical features that were available in primary care settings. We have developed a prediction model using logistic regression and have simplified it to formulate a practical tool. We assessed its predictive performance using the area under the receiver operating characteristic curve. Results Of the 73 asthmatic children with baseline and follow-up outcome measurements for inhaled corticosteroids treatment, 24 (33%) were defined as non-responders. The tool we have developed consisted of three predictors yielding a total score between 0 and 5, which are comprised of the following parameters: the age at physician-diagnosis of asthma, sex, and exhaled nitric oxide. Sensitivity and specificity of the tool for prediction of inhaled corticosteroids non-responsiveness, for a score of 3, were 0.75 and 0.69, respectively. The areas under the receiver operating characteristic curve for the prediction tool was 0.763. Conclusions Our prediction tool represents a simple and low-cost method for predicting the response of inhaled corticosteroids treatment in asthmatic children.
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Affiliation(s)
- Yi-Fan Wu
- Department of Family Medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Ming-Wei Su
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ching-Hui Tsai
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yungling L Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. .,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
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11
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Galant SP, Komarow HD, Shin HW, Siddiqui S, Lipworth BJ. The case for impulse oscillometry in the management of asthma in children and adults. Ann Allergy Asthma Immunol 2017; 118:664-671. [PMID: 28583260 DOI: 10.1016/j.anai.2017.04.009] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/16/2017] [Accepted: 04/11/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To provide a clinical rationale for including impulse oscillometry (IOS) as a part of standard office-based asthma assessment. DATA SOURCES PubMed and Google search, limited to English language and human disease, with the keywords IOS and asthma. STUDY SELECTIONS Articles included in this review were based on the expert opinion and previous publications by the authors. RESULTS In children, IOS was more useful than spirometry in identifying asthma and uncontrolled asthma and predicting loss of control and exacerbations. IOS predicts young children at risk for loss of lung function with age and the potential for early intervention to prevent further sequelae. In adults, peripheral airway impairment detected by IOS or spirometry (ie, forced expiratory flow between 25% and 75%) commonly occurs across severity, and each measure may be complementary in predicting loss of control even with normal forced expiratory volume in 1 second. Extrafine inhaled corticosteroids with or without long-acting β-agonists proved superior to standard particle aerosols in improving IOS-detected peripheral airway obstruction. Our data also suggest that currently available commercial reference values for lung resistance at 5 Hz and lung reactance at 5 Hz are applicable across diverse populations, but further studies are needed. CONCLUSION The findings of this review suggest that IOS can add value to traditional clinical and spirometric assessment and thus improve management of asthma in children and adults, as well as have the potential to detect early dysfunction of the peripheral airways, which may result in better outcomes.
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Affiliation(s)
| | - Hirsh D Komarow
- Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | - Hye-Won Shin
- Pediatrics and Pediatrics Exercise and Genomics Research Center, University of California, Irvine, Irvine, California
| | - Salman Siddiqui
- Department of Infection, Immunity and Inflammation, Respiratory Biomedical Research Unit, Glenfield Hospital, Leicester, England
| | - Brian J Lipworth
- Scottish Centre for Respiratory Research Ninewells Hospital, Dundee, Scotland
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Brehm JM, Ramratnam SK, Tse SM, Croteau-Chonka DC, Pino-Yanes M, Rosas-Salazar C, Litonjua AA, Raby BA, Boutaoui N, Han YY, Chen W, Forno E, Marsland AL, Nugent NR, Eng C, Colón-Semidey A, Alvarez M, Acosta-Pérez E, Spear ML, Martinez FD, Avila L, Weiss ST, Soto-Quiros M, Ober C, Nicolae DL, Barnes KC, Lemanske RF, Strunk RC, Liu A, London SJ, Gilliland F, Sleiman P, March M, Hakonarson H, Duan QL, Kolls JK, Fritz GK, Hu D, Fani N, Stevens JS, Almli LM, Burchard EG, Shin J, McQuaid EL, Ressler K, Canino G, Celedón JC. Stress and Bronchodilator Response in Children with Asthma. Am J Respir Crit Care Med 2015; 192:47-56. [PMID: 25918834 DOI: 10.1164/rccm.201501-0037oc] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
RATIONALE Stress is associated with asthma morbidity in Puerto Ricans (PRs), who have reduced bronchodilator response (BDR). OBJECTIVES To examine whether stress and/or a gene regulating anxiety (ADCYAP1R1) is associated with BDR in PR and non-PR children with asthma. METHODS This was a cross-sectional study of stress and BDR (percent change in FEV1 after BD) in 234 PRs ages 9-14 years with asthma. We assessed child stress using the Checklist of Children's Distress Symptoms, and maternal stress using the Perceived Stress Scale. Replication analyses were conducted in two cohorts. Polymorphisms in ADCYAP1R1 were genotyped in our study and six replication studies. Multivariable models of stress and BDR were adjusted for age, sex, income, environmental tobacco smoke, and use of inhaled corticosteroids. MEASUREMENTS AND MAIN RESULTS High child stress was associated with reduced BDR in three cohorts. PR children who were highly stressed (upper quartile, Checklist of Children's Distress Symptoms) and whose mothers had high stress (upper quartile, Perceived Stress Scale) had a BDR that was 10.2% (95% confidence interval, 6.1-14.2%) lower than children who had neither high stress nor a highly stressed mother. A polymorphism in ADCYAP1R1 (rs34548976) was associated with reduced BDR. This single-nucleotide polymorphism is associated with reduced expression of the gene for the β2-adrenergic receptor (ADRB2) in CD4(+) lymphocytes of subjects with asthma, and it affects brain connectivity of the amygdala and the insula (a biomarker of anxiety). CONCLUSIONS High child stress and an ADCYAP1R1 single-nucleotide polymorphism are associated with reduced BDR in children with asthma. This is likely caused by down-regulation of ADRB2 in highly stressed children.
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Affiliation(s)
- John M Brehm
- 1 Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, and
| | - Sima K Ramratnam
- 1 Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, and
| | - Sze Man Tse
- 2 Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Damien C Croteau-Chonka
- 2 Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria Pino-Yanes
- 3 Department of Bioengineering and Therapeutic Sciences and.,4 Department of Medicine, University of California at San Francisco, San Francisco, California.,5 CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Christian Rosas-Salazar
- 1 Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, and
| | - Augusto A Litonjua
- 2 Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin A Raby
- 2 Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nadia Boutaoui
- 1 Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, and
| | - Yueh-Ying Han
- 1 Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, and
| | - Wei Chen
- 1 Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, and
| | - Erick Forno
- 1 Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, and
| | - Anna L Marsland
- 6 Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nicole R Nugent
- 7 Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, Rhode Island
| | - Celeste Eng
- 3 Department of Bioengineering and Therapeutic Sciences and.,4 Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Angel Colón-Semidey
- 8 Behavioral Sciences Research Institute, University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - María Alvarez
- 8 Behavioral Sciences Research Institute, University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - Edna Acosta-Pérez
- 8 Behavioral Sciences Research Institute, University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - Melissa L Spear
- 3 Department of Bioengineering and Therapeutic Sciences and.,4 Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Fernando D Martinez
- 9 Arizona Respiratory Center and BIO5 Institute, University of Arizona, Tucson, Arizona
| | - Lydiana Avila
- 10 Division of Pediatric Pulmonology, Hospital Nacional de Niños, San José, Costa Rica
| | - Scott T Weiss
- 2 Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Manuel Soto-Quiros
- 10 Division of Pediatric Pulmonology, Hospital Nacional de Niños, San José, Costa Rica
| | - Carole Ober
- 11 Department of Human Genetics, University of Chicago, Chicago, Illinois
| | - Dan L Nicolae
- 11 Department of Human Genetics, University of Chicago, Chicago, Illinois
| | - Kathleen C Barnes
- 12 Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Robert F Lemanske
- 13 Department of Pediatrics and.,14 Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Robert C Strunk
- 15 Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew Liu
- 16 Department of Pediatrics, National Jewish Health, Denver, Colorado
| | - Stephanie J London
- 17 National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, North Carolina
| | - Frank Gilliland
- 18 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Patrick Sleiman
- 19 The Center for Applied Genomics, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania.,20 Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael March
- 19 The Center for Applied Genomics, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania
| | - Hakon Hakonarson
- 19 The Center for Applied Genomics, The Children's Hospital of Philadelphia Research Institute, Philadelphia, Pennsylvania.,20 Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Qing Ling Duan
- 2 Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay K Kolls
- 1 Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, and
| | - Gregory K Fritz
- 7 Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, Rhode Island
| | - Donglei Hu
- 3 Department of Bioengineering and Therapeutic Sciences and.,4 Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Negar Fani
- 21 Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia; and
| | - Jennifer S Stevens
- 21 Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia; and
| | - Lynn M Almli
- 21 Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia; and
| | - Esteban G Burchard
- 3 Department of Bioengineering and Therapeutic Sciences and.,4 Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Jaemin Shin
- 22 Center for Advanced Brain Imaging, Georgia Institute of Technology and Georgia State University, Atlanta, Georgia
| | - Elizabeth L McQuaid
- 7 Department of Psychiatry and Human Behavior, Brown University School of Medicine, Providence, Rhode Island
| | - Kerry Ressler
- 21 Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, Georgia; and
| | - Glorisa Canino
- 8 Behavioral Sciences Research Institute, University of Puerto Rico, Medical Science Campus, San Juan, Puerto Rico
| | - Juan C Celedón
- 1 Division of Pulmonary Medicine, Allergy and Immunology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, and
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Noah TL, Yilmaz O, Nicolai T, Birnkrant D, Praud JP. Pediatric Pulmonology year in review 2014: Part 1. Pediatr Pulmonol 2015; 50:621-9. [PMID: 25891206 DOI: 10.1002/ppul.23202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/29/2015] [Indexed: 11/08/2022]
Abstract
Our discipline and our journal cover an extremely broad range of research and scholarly topics related to children's respiratory disorders. To better meet the needs of our readership for updated perspectives on the rapidly expanding knowledge in our field, we here summarize the past year's publications in our major topic areas, as well as selected publications in these areas from the core clinical journal literature outside our own pages.
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Affiliation(s)
- Terry L Noah
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ozge Yilmaz
- Pediatric Allergy and Pulmonology, Celal Bayar University Department of Pediatrics, Manisa, Turkey
| | | | - David Birnkrant
- MetroHealth Medical Center Department of Pediatrics, Cleveland, Ohio
| | - Jean-Paul Praud
- University Sherbrooke Pediatrics, Sherbrooke, Quebec, Canada
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Hoshino Y, Koya T, Kagamu H, Tsukioka K, Toyama M, Sakagami T, Hasegawa T, Narita I, Arakawa M, Suzuki E. Effect of inhaled corticosteroids on bronchial asthma in Japanese athletes. Allergol Int 2015; 64:145-9. [PMID: 25838089 DOI: 10.1016/j.alit.2014.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 08/25/2014] [Accepted: 09/28/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Asthma has a higher prevalence in athlete populations such as Olympic athletes than in the general population. Correct diagnosis and management of asthma in athletes is important for symptom control and avoidance of doping accusations. However, few reports are available on asthma treatment in the athlete population in clinical practice. In this study, we focused on the clinical efficacy of inhaled corticosteroid (ICS) for asthma in a Japanese athlete population. METHODS The study subjects included athletes who visited the Niigata Institute for Health and Sports Medicine, Niigata, Japan for athletic tests and who were diagnosed with asthma on the basis of respiratory symptoms and positive results in a bronchodilator or bronchial provocation test such as exercise, hypertonic saline, or methacholine provocation. The athletes received ICS alone for at least 3 months, and the clinical background, sports type, and treatment efficacy were analyzed. RESULTS The study population comprised 80 athletes (59 men and 21 women) with a median age of 16.0 years. Regarding sports type, 28 athletes engaged in winter sports (35%), 22 in endurance sports (27.5%), and 25 in indoor sports (31.3%). Although ICS is the primary treatment in athlete asthma, 16.3% of the athletes showed an unsatisfactory response to treatment according to the Global Evaluation of Treatment Effectiveness (GETE). These subjects were characterized by a decreased response to methacholine and lower values for FEV1/FVC and type 2 helper T cell (Th2)-associated biomarkers relative to responsive athletes. In multivariate analysis, FEV1/FVC and the logarithm to the base 10 of the IgE level were independently associated with the ICS response. CONCLUSIONS These data suggest that ICS is effective for asthma in most athletes. However, certain asthmatic athletes are less responsive to ICS than expected. The pathogenesis in these subjects may differ from that of conventional asthma characterized by chronic allergic airway inflammation.
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Affiliation(s)
- Yoshifumi Hoshino
- Division of Respiratory Medicine, Department of Homeostatic Regulation and Development, Course in Biological Functions and Medical Control, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshiyuki Koya
- Division of Respiratory Medicine, Department of Homeostatic Regulation and Development, Course in Biological Functions and Medical Control, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
| | - Hiroshi Kagamu
- Division of Respiratory Medicine, Department of Homeostatic Regulation and Development, Course in Biological Functions and Medical Control, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Keisuke Tsukioka
- Division of Respiratory Medicine, Department of Homeostatic Regulation and Development, Course in Biological Functions and Medical Control, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Mio Toyama
- Division of Respiratory Medicine, Department of Homeostatic Regulation and Development, Course in Biological Functions and Medical Control, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takuro Sakagami
- Division of Respiratory Medicine, Department of Homeostatic Regulation and Development, Course in Biological Functions and Medical Control, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Hasegawa
- Department of General Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Ichiei Narita
- Division of Respiratory Medicine, Department of Homeostatic Regulation and Development, Course in Biological Functions and Medical Control, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masaaki Arakawa
- Niigata Institute for Health and Sports Medicine, Niigata, Japan
| | - Eiichi Suzuki
- Department of General Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
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