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Difficult and Severe Asthma in Children. CHILDREN-BASEL 2020; 7:children7120286. [PMID: 33322016 PMCID: PMC7764801 DOI: 10.3390/children7120286] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/24/2022]
Abstract
Asthma is the most frequent chronic inflammatory disease of the lower airways affecting children, and it can still be considered a challenge for pediatricians. Although most asthmatic patients are symptom-free with standard treatments, a small percentage of them suffer from uncontrolled persistent asthma. In these children, a multidisciplinary systematic assessment, including comorbidities, treatment-related issues, environmental exposures, and psychosocial factors is needed. The identification of modifiable factors is important to differentiate children with difficult asthma from those with true severe therapy-resistant asthma. Early intervention on modifiable factors for children with difficult asthma allows for better control of asthma without the need for invasive investigation and further escalation of treatment. Otherwise, addressing a correct diagnosis of true severe therapy-resistant asthma avoids diagnostic and therapeutic delays, allowing patients to benefit from using new and advanced biological therapies.
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Yoshida S, Tanaka S, Adachi Y, Yoshisue H, Kozawa M, Kawakami K. Assessment of asthma severity according to treatment steps in Japanese pediatric patients: a descriptive cross-sectional study using an administrative claims database. J Asthma 2020; 58:1574-1580. [PMID: 32900270 DOI: 10.1080/02770903.2020.1821057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Japan has one of the highest asthma prevalence rates in Asia; however, there is a lack of epidemiological studies on asthma among children in Japan. This study aimed to describe the severity of asthma and the prescription patterns for its treatment among pediatric patients, by using a large-scale claims database. METHODS The analysis datasets were extracted from the JMDC database for the period of April 1, 2009 to March 30, 2015; included records were restricted to patients between 2 and 15 years of age. The Japanese Pediatric Guidelines for the treatment and management of asthma (JPGL) steps were used as a proxy for asthma treatment and severity. We also described the characteristics of asthma in children by stratifying the prevalence and incidence cohorts by index years. RESULTS In the prevalence cohort (56% male), from 2010 to 2014, approximately 80-90% of the children received step 1 or 2 treatment, with the remainder receiving step 3 or 4 treatment, as defined by the JPGL. The majority (approximately 90%) of patients visited clinics for asthma treatment, while a minority visited hospitals. CONCLUSIONS Our study showed the severity of asthma among Japanese pediatric patients, as well as their demographic characteristics, using a large-scale claims database. The majority of pediatric asthma patients received treatment for mild-to-moderate asthma, while less than 10% received treatment for severe asthma.
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Affiliation(s)
- Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Shiro Tanaka
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yuichi Adachi
- Department of Pediatrics, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | | | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
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Bersuch E, Gräf F, Renner ED, Jung A, Traidl-Hoffmann C, Lauener R, Roduit C. Lung function improvement and airways inflammation reduction in asthmatic children after a rehabilitation program at moderate altitude. Pediatr Allergy Immunol 2017; 28:768-775. [PMID: 28981975 DOI: 10.1111/pai.12808] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rehabilitational programs at moderate altitude (1500-2500 m) showed improvement of lung function and reduction in airways inflammation in asthmatic adults. Allergen avoidance was postulated as the major cause of these improvements. METHODS Spirometries of 344 and fractional exhaled nitric oxide measurements (FeNO) of 124 asthmatic children and adolescents, staying in a rehabilitation hospital in Davos (1590 m) with at least 14 days between admission and discharge, were analyzed in association with atopic sensitization (skin-prick testing and/or specific IgE), level of asthma control, and inhalative corticosteroid (ICS) dose. RESULTS Pulmonary conditions improved significantly on average during the sojourn. Uncontrolled asthmatics benefited most with an absolute increase in predicted FEV1 , MEF25 , and MEF75 of 7.7%, 9.9%, and 12.7%, respectively (P < .001). FeNO decreased by 36.9 ppb for uncontrolled, by 26.9 ppb for partly controlled, and by 11.8 ppb for controlled asthmatics. In uncontrolled subjects, pulmonary improvement was comparable between patients with and without house dust mites (HDM) sensitization. Pulmonary improvements of pollen-sensitized patients were not dependent on the season of the sojourn. For the group with constant ICS level, the absolute increase in FEV1 was 4.9% (P < .001) with a FeNO decreased by 32.7 ppb (P < .001). When the ICS dose was elevated by one GINA level, the absolute increase in FEV1 was slightly higher (6.6%, P < .001), with a FeNO decrease of 31.4 ppb (P < .001). CONCLUSION Inpatient rehabilitation at moderate altitude improved pulmonary conditions in asthmatic children and adolescents independent of sensitization status to HDM or pollen. A positive effect was also observed in patients without change in medication.
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Affiliation(s)
- Eugen Bersuch
- CK-CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,Department of Dermatology, Allergy Unit, Zurich University Hospital, Zurich, Switzerland
| | - Florian Gräf
- CK-CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,Institute for Medical Information Processing, Biometry and Epidemiology (IBE), LMU Munich, Munich, Germany
| | - Ellen D Renner
- CK-CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,Hochgebirgsklinik Davos, Davos, Switzerland.,Chair and Institute of Environmental Medicine, UNIKA-T, Technical University Munich and Helmholtz Zentrum, München, Germany
| | - Andreas Jung
- Hochgebirgsklinik Davos, Davos, Switzerland.,Children's University Hospital Zurich, Zurich, Switzerland
| | - Claudia Traidl-Hoffmann
- CK-CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,Chair and Institute of Environmental Medicine, UNIKA-T, Technical University Munich and Helmholtz Zentrum, München, Germany
| | - Roger Lauener
- CK-CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,Children's Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Caroline Roduit
- CK-CARE, Christine Kühne Center for Allergy Research and Education, Davos, Switzerland.,Children's University Hospital Zurich, Zurich, Switzerland
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Chen M, Lv Z, Huang L, Zhang W, Lin X, Shi J, Zhang W, Liang R, Jiang S. Triptolide inhibits TGF-β1-induced cell proliferation in rat airway smooth muscle cells by suppressing Smad signaling. Exp Cell Res 2014; 331:362-8. [PMID: 25447441 DOI: 10.1016/j.yexcr.2014.10.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/17/2014] [Accepted: 10/19/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND We have reported that triptolide can inhibit airway remodeling in a murine model of asthma via TGF-β1/Smad signaling. In the present study, we aimed to investigate the effect of triptolide on airway smooth muscle cells (ASMCs) proliferation and the possible mechanism. METHODS Rat airway smooth muscle cells were cultured and made synchronized, then pretreated with different concentration of triptolide before stimulated by TGF-β1. Cell proliferation was evaluated by MTT assay. Flow cytometry was used to study the influence of triptolide on cell cycle and apoptosis. Signal proteins (Smad2, Smad3 and Smad7) were detected by western blotting analysis. RESULTS Triptolide significantly inhibited TGF-β1-induced ASMC proliferation (P<0.05). The cell cycle was blocked at G1/S-interphase by triptolide dose dependently. No pro-apoptotic effects were detected under the concentration of triptolide we used. Western blotting analysis showed TGF-β1 induced Smad2 and Smad3 phosphorylation was inhibited by triptolide pretreatment, and the level of Smad7 was increased by triptolide pretreatment. CONCLUSIONS Triptolide may function as an inhibitor of asthma airway remodeling by suppressing ASMCs proliferation via negative regulation of Smad signaling pathway.
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Affiliation(s)
- Ming Chen
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Institute for Respiratory disease of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, Guangdong Province 510120, China
| | - Zhiqiang Lv
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Institute for Respiratory disease of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, Guangdong Province 510120, China
| | - Linjie Huang
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Institute for Respiratory disease of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, Guangdong Province 510120, China
| | - Wei Zhang
- Department of Geratology, the Second People׳s Hospital of Shenzhen, Shenzhen 518000, China
| | - Xiaoling Lin
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Institute for Respiratory disease of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, Guangdong Province 510120, China
| | - Jianting Shi
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Institute for Respiratory disease of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, Guangdong Province 510120, China
| | - Wei Zhang
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Institute for Respiratory disease of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, Guangdong Province 510120, China
| | - Ruiyun Liang
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Institute for Respiratory disease of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, Guangdong Province 510120, China
| | - Shanping Jiang
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Institute for Respiratory disease of Sun Yat-sen University, Sun Yat-sen University, Guangzhou, Guangdong Province 510120, China.
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Hung YC, Hung IL, Sun MF, Muo CH, Wu BY, Tseng YJ, Hu WL. Integrated traditional Chinese medicine for childhood asthma in Taiwan: a Nationwide cohort study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:389. [PMID: 25304233 PMCID: PMC4198671 DOI: 10.1186/1472-6882-14-389] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 10/06/2014] [Indexed: 11/23/2022]
Abstract
Background Traditional Chinese medicine (TCM) is the most commonly used alternative therapy in children with asthma, especially in the Chinese community. This study aimed to investigate the effects of the government-sponsored Outpatient’s Healthcare Quality Improvement (OHQI) project with integrated TCM treatment on childhood asthma. Methods This study used the Longitudinal Health Insurance Database 2000, which is a part of the Taiwan National Health Insurance Research Database (NHIRD). Children with diagnosed asthma and aged under 15 years from 2006–2010 were enrolled. They were collated into 3 groups: (1) subjects treated with non-TCM; (2) subjects treated with single TCM; and (3) subjects treated with integrative OHQI TCM. The medical visits and the cost of treatment paid by the Bureau of National Health Insurance (BNHI) to the outpatient, emergency room, and inpatient departments were evaluated for the study subjects within 1 year of the first asthma diagnosis during the study period. Results Fifteen multi-hospitals, including 7 medical centers, and 35 TCM physicians participated in OHQI during the study period. A total of 12850 children from the NHIRD database were enrolled in this study, and divided as follows: 12435 children in non-TCM group, 406 children in single TCM group, and 9 children in integrative OHQI TCM group. Although the total medical cost paid by the BNHI per patient in the integrative OHQI TCM group was greater than that in the non-OHQI groups, the patients in the integrative OHQI TCM group exhibited greater therapeutic effects, and did not require ER visits or hospitalization. In addition, ER visits and hospitalization among patients who received a combination of conventional therapy with integrated TCM were lower than those among patients who underwent conventional therapy alone or single TCM treatment. Conclusions Asthmatic children at partly controlled level under conventional therapy may benefit from adjuvant treatment with integrated TCM.
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Chen M, Shi JT, Lv ZQ, Huang LJ, Lin XL, Zhang W, Liang RY, Li YQ, Jiang SP. Triptolide inhibits TGF-β1 induced proliferation and migration of rat airway smooth muscle cells by suppressing NF-κB but not ERK1/2. Immunology 2014; 144:486-494. [PMID: 25267491 PMCID: PMC4557685 DOI: 10.1111/imm.12396] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/25/2014] [Accepted: 09/23/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Airway remodeling contributes to increased mortality in asthma. We have reported that triptolide can inhibit airway remodeling in a mouse asthma model. In this study, we aimed to investigate the effect of triptolide on airway smooth muscle cells (ASMCs) proliferation, migration and the possible mechanism. METHODS Rat airway smooth muscle cells were cultured and made synchronized, then pretreated with different concentrations of triptolide before stimulated by TGF-β1. Cell proliferation was evaluated by cell counting and MTT assay. Flow cytometry was used to study the influence of triptolide on cell cycle. Migration was measured by Transwell analysis. Signal proteins (NF-κB p65 and ERK1/2) were detected by western blotting analysis. LDH releasing test and flow cytometry analysis of apoptosis were also performed to explore the potential cytotoxic or pro-apoptotic effects of triptolide. RESULTS Triptolide significantly inhibited TGF-β1 induced ASMC proliferation and migration (p<0.05). The cell cycle was blocked at G1/S-interphase by triptolide dose dependently. Western blotting analysis showed TGF-β1 induced NF-κB p65 phosphorylation was inhibited by triptolide pretreatment, but ERK1/2 was not affected. No cytotoxic or pro-apoptotic effects were detected under the concentration of triptolide we used. CONCLUSIONS Triptolide may function as an inhibitor of asthma airway remodeling by suppressing ASMCs proliferation and migration through inactivation of NF-κB pathway. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ming Chen
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Jian-Ting Shi
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Zhi-Qiang Lv
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Lin-Jie Huang
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Xiao-Ling Lin
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Wei Zhang
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Rui-Yun Liang
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Yi-Qun Li
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
| | - Shan-Ping Jiang
- Department of Respiratory Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-sen UniversityGuangzhou, China
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Tang W, Xie Q, Guan J, Jin S, Zhao Y. Phytochemical profiles and biological activity evaluation of Zanthoxylum bungeanum Maxim seed against asthma in murine models. JOURNAL OF ETHNOPHARMACOLOGY 2014; 152:444-450. [PMID: 24495470 DOI: 10.1016/j.jep.2014.01.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 12/04/2013] [Accepted: 01/14/2014] [Indexed: 06/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Zanthoxylum bungeanum Maxim seed (ZBMS) has been used in Traditional Chinese Medicine (TCM) as an ingredient of polyherbal formulations for the treatment of inflammation and asthma. The aim of this study was to analyze the major composition and to evaluate the anti-asthma activity of ZBMS. MATERIALS AND METHODS Some murine models including acetylcholine/histamine-induced asthma, ovalbumin-induced airway inflammation, ear edema and toe swelling measurement, citric acid-induced cough, and anti-stress abilities were investigated to fully study the anti-asthma activity of ZBMS.GC chromatography was also performed to analyze the major fatty acid composition of ZBMS. RESULTS The results demonstrated that the major fatty acid composition of ZBMS includes oleic acid (20.15%), linoleic acid (26.54%), and α-linolenic acid (30.57%), which was the leading component of ZBMS, and that the total fatty acid content of ZBMS was 77.27%. The murine models demonstrated that ZBMS displays a protective effect on guinea pig sensitization, a dose-dependent inhibition of the increases in RL and decreases in Cdyn, which resulted in the relief of auricle edema and toe swelling in mice and anti-stress activity. CONCLUSION Our results validate the traditional use of ZBMS for the treatment of asthma and other inflammatory joint disorders, and suggest that ZBMS has potential as a new therapeutic agent for asthma management.
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Affiliation(s)
- Weizhuo Tang
- School of Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, People׳s Republic of China; Key Laboratory of Structure-Based Drug Design & Discovery Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, People׳s Republic of China
| | - Qiangmin Xie
- Zhejiang Respiratory Drugs Research Laboratory of State Food and Drug Administration of China, Medical College of Zhejiang University, Hangzhou 310058, People׳s Republic of China
| | - Jian Guan
- Liaoning Province Institute of Pharmaceutical Research, Shenyang 110015, People׳s Republic of China
| | - Saihong Jin
- Zhejiang Respiratory Drugs Research Laboratory of State Food and Drug Administration of China, Medical College of Zhejiang University, Hangzhou 310058, People׳s Republic of China
| | - Yuqing Zhao
- School of Chinese Materia Medica, Shenyang Pharmaceutical University, Shenyang 110016, People׳s Republic of China; Key Laboratory of Structure-Based Drug Design & Discovery Ministry of Education, Shenyang Pharmaceutical University, Shenyang 110016, People׳s Republic of China.
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