1
|
Chaogang X, Mengna A, Zhen W, Ying L, Xin G, Xin Z, Shengjie Z, Yuan Z, Qian L, Wenbin M, Weiyi F. Cost-effectiveness of mepolizumab for severe eosinophilic asthma in China. J Asthma 2024; 61:1068-1075. [PMID: 38470879 DOI: 10.1080/02770903.2024.2324855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/16/2024] [Accepted: 02/25/2024] [Indexed: 03/14/2024]
Abstract
OBJECTIVE To evaluate the economic value of mepolizumab as an add-on therapy to the standard of care (SoC) for patients with severe eosinophilic asthma in China. METHODS A Markov model with three health conditions was constructed to calculate the incremental cost per quality-adjusted life year (QALY) in mepolizumab with SoC and SoC only groups from the perspective of the Chinese healthcare system throughout an entire lifespan. The model was populated with local costs, while efficacy parameters were obtained from the global Phase III MENSA trial and mortality was derived from two surveys. One-way and probabilistic sensitivity analyses were conducted. Additional scenario analysis was used to estimate the cost-effectiveness impact of changes in the price of mepolizumab. RESULTS Over the lifetime treatment horizon, the incremental cost-effectiveness ratio (ICER) of mepolizumab plus SoC compared to SoC alone was $170 648.73 per QALY. Sensitivity analyses focused on these results. Scenario analysis showed that mepolizumab would require a price reduction of at least 82% to reach the current willingness-to-pay (WTP=$38 223.34/QALY) threshold. CONCLUSION Mepolizumab is not a cost-effective healthcare resource in China at its current pricing.
Collapse
Affiliation(s)
- Xiong Chaogang
- Department of Pharmacy, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - An Mengna
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Wang Zhen
- Department of Pharmacy, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi Province, China
| | - Li Ying
- Department of Pharmacy, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - Gu Xin
- Department of Pharmacy, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - Zhang Xin
- Department of Pharmacy, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - Zhang Shengjie
- Department of Pharmacy, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - Zhao Yuan
- Department of Pharmacy, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - Lei Qian
- Department of Pharmacy, Xi'an Chest Hospital, Xi'an, Shaanxi Province, China
| | - Ma Wenbin
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Feng Weiyi
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| |
Collapse
|
2
|
Wilson GE, Knight J, Liu Q, Shelar A, Stewart E, Wang X, Yan X, Sanders J, Visness C, Gill M, Gruchalla R, Liu AH, Kattan M, Khurana Hershey GK, Togias A, Becker PM, Altman MC, Busse WW, Jackson DJ, Montgomery RR, Chupp GL. Activated sputum eosinophils associated with exacerbations in children on mepolizumab. J Allergy Clin Immunol 2024; 154:297-307.e13. [PMID: 38485057 PMCID: PMC11305967 DOI: 10.1016/j.jaci.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND MUPPITS-2 was a randomized, placebo-controlled clinical trial that demonstrated mepolizumab (anti-IL-5) reduced exacerbations and blood and airway eosinophils in urban children with severe eosinophilic asthma. Despite this reduction in eosinophilia, exacerbation risk persisted in certain patients treated with mepolizumab. This raises the possibility that subpopulations of airway eosinophils exist that contribute to breakthrough exacerbations. OBJECTIVE We aimed to determine the effect of mepolizumab on airway eosinophils in childhood asthma. METHODS Sputum samples were obtained from 53 MUPPITS-2 participants. Airway eosinophils were characterized using mass cytometry and grouped into subpopulations using unsupervised clustering analyses of 38 surface and intracellular markers. Differences in frequency and immunophenotype of sputum eosinophil subpopulations were assessed based on treatment arm and frequency of exacerbations. RESULTS Median sputum eosinophils were significantly lower among participants treated with mepolizumab compared with placebo (58% lower, 0.35% difference [95% CI 0.01, 0.74], P = .04). Clustering analysis identified 3 subpopulations of sputum eosinophils with varied expression of CD62L. CD62Lint and CD62Lhi eosinophils exhibited significantly elevated activation marker and eosinophil peroxidase expression, respectively. In mepolizumab-treated participants, CD62Lint and CD62Lhi eosinophils were more abundant in participants who experienced exacerbations than in those who did not (100% higher for CD62Lint, 0.04% difference [95% CI 0.0, 0.13], P = .04; 93% higher for CD62Lhi, 0.21% difference [95% CI 0.0, 0.77], P = .04). CONCLUSIONS Children with eosinophilic asthma treated with mepolizumab had significantly lower sputum eosinophils. However, CD62Lint and CD62Lhi eosinophils were significantly elevated in children on mepolizumab who had exacerbations, suggesting that eosinophil subpopulations exist that contribute to exacerbations despite anti-IL-5 treatment.
Collapse
Affiliation(s)
- Gabriella E Wilson
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - James Knight
- Department of Genetics and Yale Center for Genome Analysis, Yale School of Medicine, New Haven, Conn
| | - Qing Liu
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Ashish Shelar
- Department of Genetics and Yale Center for Genome Analysis, Yale School of Medicine, New Haven, Conn
| | - Emma Stewart
- Committee on Immunology, University of Chicago, Chicago, Ill
| | - Xiaomei Wang
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Xiting Yan
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | | | | | - Michelle Gill
- Department of Pediatric Infectious Diseases, Washington University in St Louis School of Medicine, St Louis, Mo
| | - Rebecca Gruchalla
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - Andrew H Liu
- Department of Pediatrics, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo
| | - Meyer Kattan
- Department of Pediatric Pulmonology, Columbia University Irving Medical Center, New York, NY
| | | | - Alkis Togias
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Patrice M Becker
- National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | | | - William W Busse
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Daniel J Jackson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Ruth R Montgomery
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Geoffrey L Chupp
- Department of Internal Medicine, Yale School of Medicine, New Haven, Conn.
| |
Collapse
|
3
|
Candan O, Toptas T, Demir S, Erdenen F. There is no association between serum endotoxin levels and inflammation in asthma. J Asthma 2024; 61:883-888. [PMID: 38289083 DOI: 10.1080/02770903.2024.2311233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
BACKROUND Endotoxin, in lipopolysaccharide structure (LPS), is the main component of the outer membrane of gram negative bacteria. LPS levels were associated with inflammatory disease. Asthma is a chronic inflammatory disease involving many different cell types and cellular elements. The association between LPS serum levels and the asthma is not well known. The aim of this study was to investigate the association between the LPS serum levels and the severity of asthma, demographic data and laboratory parameters. METHODOLOGY The study included 67 patients aged >18 years with a diagnosis of asthma, and 15 healthy volunteers with no history of chronic disease as a control group. The Asthma Control Test (ACT), Respiratory Function Tests (RFTs), fractional exhaled nitric oxide (FeNO), and endotoxin levels were measured and compared between the groups. The endotoxin measurements were performed using the ELISA method. RESULTS The mild-moderate asthma group included 33 patients and the severe asthma group, 34 patients. The endotoxin level was measured as 17.78 (range 3.59 to 304.55) EU/ml in the patient group and 15 (range 4.01 to 74.06) EU/ml in the control group with no statistically significant difference determined between the groups. In the subgroups, the endotoxin level was measured as 15.21 (range 3.69 to 304.55) EU/ml in the mild-moderate group and 14.46 (range 3.59 to 278.86) EU/ml in the severe asthma group with no statistically significant difference determined between the groups. CONCLUSION The results of this study showed no relationship between serum endotoxin level and asthma or asthma severity.
Collapse
Affiliation(s)
- Ozlem Candan
- Division of Hematology, Marmara Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Tayfur Toptas
- Division of Hematology, Marmara Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Semra Demir
- Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Fusun Erdenen
- Adult Allergy and Immunology Clinic, Istanbul Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
4
|
Yao Y, Yang Y, Ji M, Qin Q, Xu K, Xia Z, Liu H, Yuan L, Yuan Y, Qin L, Du X, Wang L, Zhou K, Wu X, Wang W, Qing B, Xiang Y, Qu X, Yang M, Qin X, Liu C. Airway epithelial-derived exosomes induce acute asthma exacerbation after respiratory syncytial virus infection. MedComm (Beijing) 2024; 5:e621. [PMID: 38938285 PMCID: PMC11208743 DOI: 10.1002/mco2.621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/29/2024] Open
Abstract
Acute asthma exacerbation refers to the progressive deterioration of asthma symptoms that is always triggered by virus infection represented by respiratory syncytial virus (RSV). After RSV infection, exaggerated Th2-mediated pulmonary inflammation is the critical pathological response of asthmatic patients with acute exacerbation. Significantly, airway epithelial cells, being the primary targets of RSV infection, play a crucial role in controlling the pulmonary inflammatory response by releasing airway epithelial cell-derived exosomes (AEC-Exos), which potentially influence the development of asthma. However, the specific role of AEC-Exos in acute asthma exacerbation after RSV infection remains obscure. The purpose of this study was to determine the distinct function of AEC-Exos in exacerbating acute asthma following RSV infection. Blockade of exosomes by GW reduce the enhanced pulmonary inflammation significantly. Specifically, the enhanced Th2 inflammation was induced by AEC-Exos thorough transportation of hsa-miR-155-5p-Sirtuin 1 (SIRT1) pathway during acute asthma exacerbation. Targeted inhibition of hsa-miR-155-5p blocks the exaggerated Th2 inflammation effectively in mice with acute asthma exacerbation. In summary, our study showed that during acute asthma exacerbation after RSV infection, AEC-Exos promote the enhanced Th2 inflammation through transportation of increased hsa-miR-155-5p, which was mediated partly through SIRT1-mediated pathway. hsa-miR-155-5p is a potential biomarker for early prediction of acute asthma exacerbation.
Collapse
Affiliation(s)
- Ye Yao
- Department of Respiratory MedicineNational Clinical Research Center for Respiratory DiseasesXiangya HospitalCentral South UniversityChangshaChina
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Yu Yang
- Department of Respiratory MedicineNational Clinical Research Center for Respiratory DiseasesXiangya HospitalCentral South UniversityChangshaChina
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Ming Ji
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Qingwu Qin
- Department of Pulmonary and Critical Care Medicinethe Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Kun Xu
- Department of preventive medicine, School of MedicineHunan Normal UniversityChangshaChina
| | - Zhenkun Xia
- Department of Thoracic Surgerythe Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Huijun Liu
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Lin Yuan
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Yunchang Yuan
- Department of Thoracic Surgerythe Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Ling Qin
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
- Basic and Clinical Research Laboratory of Major Respiratory DiseasesCentral South UniversityChangshaHunanChina
| | - Xizi Du
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Leyuan Wang
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Kai Zhou
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Xinyu Wu
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Weijie Wang
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Bei Qing
- Department of Thoracic Surgerythe Second Xiangya HospitalCentral South UniversityChangshaHunanChina
| | - Yang Xiang
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Xiangping Qu
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Ming Yang
- Centre for Asthma and Respiratory DiseaseSchool of Biomedical Sciences and PharmacyFaculty of Health and MedicineUniversity of Newcastle and Hunter Medical Research InstituteCallaghanNew South WalesAustralia
| | - Xiaoqun Qin
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
| | - Chi Liu
- Department of Respiratory MedicineNational Clinical Research Center for Respiratory DiseasesXiangya HospitalCentral South UniversityChangshaChina
- Department of PhysiologySchool of Basic Medicine ScienceCentral South UniversityChangshaHunanChina
- Basic and Clinical Research Laboratory of Major Respiratory DiseasesCentral South UniversityChangshaHunanChina
| |
Collapse
|
5
|
Raboso B, Pou C, Abril R, Erro M, Sánchez C, Manzano C, Zamarrón E, Suarez-Cuartin G, González J. Bronchiectasis. OPEN RESPIRATORY ARCHIVES 2024; 6:100339. [PMID: 39026515 PMCID: PMC11255363 DOI: 10.1016/j.opresp.2024.100339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/02/2024] [Indexed: 07/20/2024] Open
Abstract
Non-cystic fibrosis bronchiectasis, a condition that remains relatively underrecognized, has garnered increasing research focus in recent years. This scientific interest has catalyzed advancements in diagnostic methodologies, enabling comprehensive clinical and molecular profiling. Such progress facilitates the development of personalized treatment strategies, marking a significant step toward precision medicine for these patients. Bronchiectasis poses significant diagnostic challenges in both clinical settings and research studies. While computed tomography (CT) remains the gold standard for diagnosis, novel alternatives are emerging. These include artificial intelligence-powered algorithms, ultra-low dose chest CT, and magnetic resonance imaging (MRI) techniques, all of which are becoming recognized as feasible diagnostic tools. The precision medicine paradigm calls for refined characterization of bronchiectasis patients by analyzing their inflammatory and molecular profiles. Research into the underlying mechanisms of inflammation and the evaluation of biomarkers such as neutrophil elastase, mucins, and antimicrobial peptides have led to the identification of distinct patient endotypes. These endotypes present variable clinical outcomes, necessitating tailored therapeutic interventions. Among these, eosinophilic bronchiectasis is notable for its prevalence and specific prognostic factors, calling for careful consideration of treatable traits. A deeper understanding of the microbiome's influence on the pathogenesis and progression of bronchiectasis has inspired a holistic approach, which considers the multibiome as an interconnected microbial network rather than treating pathogens as solitary entities. Interactome analysis therefore becomes a vital tool for pinpointing alterations during both stable phases and exacerbations. This array of innovative approaches has revolutionized the personalization of treatments, incorporating therapies such as inhaled mannitol or ARINA-1, brensocatib for anti-inflammatory purposes, and inhaled corticosteroids specifically for patients with eosinophilic bronchiectasis.
Collapse
Affiliation(s)
| | | | - Rosa Abril
- University Hospital Complex Insular-Materno Infantil (CHUIMI) of Gran Canaria, Gran Canaria, Spain
| | - Marta Erro
- Puerta del Hierro University Hospital, Madrid, Spain
| | | | - Carlos Manzano
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | | | - Guillermo Suarez-Cuartin
- Hospital Universitari Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jessica González
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| |
Collapse
|
6
|
Qin L, Yao Y, Wang W, Qin Q, Liu J, Liu H, Yuan L, Yuan Y, Du X, Zhao B, Wu X, Qing B, Huang L, Wang G, Xiang Y, Qu X, Zhang X, Yang M, Xia Z, Liu C. Airway epithelial overexpressed cathepsin K induces airway remodelling through epithelial-mesenchymal trophic unit activation in asthma. Br J Pharmacol 2024. [PMID: 38853468 DOI: 10.1111/bph.16423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND AND PURPOSE Airway epithelial cells (AECs) regulate the activation of epithelial-mesenchymal trophic units (EMTUs) during airway remodelling through secretion of signalling mediators. However, the major trigger and the intrinsic pathogenesis of airway remodelling is still obscure. EXPERIMENTAL APPROACH The differing expressed genes in airway epithelia related to airway remodelling were screened and verified by RNA-sequencing and signalling pathway analysis. Then, the effects of increased cathepsin K (CTSK) in airway epithelia on airway remodelling and EMTU activation were identified both in vitro and in vivo, and the molecular mechanism was elucidated in the EMTU model. The potential of CTSK as an an effective biomarker of airway remodelling was analysed in an asthma cohort of differing severity. Finally, an inhibitor of CTSK was administered for potential therapeutic intervention for airway remodelling in asthma. KEY RESULTS The expression of CTSK in airway epithelia increased significantly along with the development of airway remodelling in a house dust mite (HDM)-stressed asthma model. Increased secretion of CTSK from airway epithelia induced the activation of EMTUs by activation of the PAR2-mediated pathway. Blockade of CTSK inhibited EMTU activation and alleviated airway remodelling as an effective intervention target of airway remodelling. CONCLUSION AND IMPLICATIONS Increased expression of CTSK in airway epithelia is involved in the development of airway remodelling in asthma through EMTU activation, mediated partly through the PAR2-mediated signalling pathway. CTSK is a potential biomarker for airway remodelling, and may also be a useful intervention target for airway remodelling in asthma patients.
Collapse
Affiliation(s)
- Ling Qin
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, China
- Basic and Clinical Research Laboratory of Major Respiratory Diseases, Central South University, Changsha, Hunan, China
| | - Ye Yao
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Weijie Wang
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, Hunan, China
| | - Qingwu Qin
- Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Jingjing Liu
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Huijun Liu
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, Hunan, China
| | - Lin Yuan
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, Hunan, China
| | - Yunchang Yuan
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xizi Du
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, Hunan, China
| | - Bingrong Zhao
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Xinyu Wu
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, Hunan, China
| | - Bei Qing
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Leng Huang
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, China
| | - Gang Wang
- Department of Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Xiang
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, Hunan, China
| | - Xiangping Qu
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, Hunan, China
| | - Xuewei Zhang
- Department of Health Management, Xiangya Hospital, Cental South University, Changsha, China
| | - Ming Yang
- Centre for Asthma and Respiratory Disease, School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle and Hunter Medical Research Institute, Callaghan, New South Wales, Australia
| | - Zhenkun Xia
- Department of Thoracic Surgery, the Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Chi Liu
- Department of Respiratory Medicine, National Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Central South University, Changsha, China
- Basic and Clinical Research Laboratory of Major Respiratory Diseases, Central South University, Changsha, Hunan, China
- Department of Physiology, School of Basic Medicine Science, Central South University, Changsha, Hunan, China
| |
Collapse
|
7
|
Okazaki R, Harada T, Funaki Y, Morita M, Takata M, Kohno H, Ishikawa H, Inui G, Nishigami M, Yamamoto M, Listyoko AS, Yamasaki A. Efficacy, Safety, and Continuation of Biological Therapy in Older Patients with Asthma in a Real-World Setting: A Retrospective Observational Study. Yonago Acta Med 2024; 67:114-123. [PMID: 38803591 PMCID: PMC11128083 DOI: 10.33160/yam.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/27/2024] [Indexed: 05/29/2024]
Abstract
Background Major randomized clinical trials have shown that biological therapy can reduce the exacerbation rate and oral corticosteroid (OCS) dosage in patients with severe eosinophilic asthma. However, data on the continuation, efficacy, and safety of biological therapy in older patients with asthma are limited. Therefore, the aim of this study was to evaluate the differences in the continuation rate, efficacy, and safety of biological therapy between older (≥ 65 years) and younger (< 65 years) patients with asthma. Methods In this single-center retrospective observational study, we collected clinical data of patients with asthma who were administered biological drugs such as omalizumab, mepolizumab, benralizumab, and dupilumab between April 2009 and August 2022. We comparatively analyzed the continuation, efficacy, and safety of biological therapy between older (age ≥ 65 years) and younger patient (age < 65 years) groups. The reasons for discontinuation or switching of biological drugs were also evaluated. Results Sixty-two (31 older and 31 younger) patients were treated with 91 biologics during the observational period. The mean age of older patients was 74.3 ± 5.1 years and that of younger patients was 48.0 ± 14.0 years. The continuation rate of biological therapy was not significantly different between the groups. Social background was the most common reason for discontinuation of biological therapy in both groups, and insufficient effect was the most common reason for switching to biological drugs. Asthma exacerbations decreased in both groups within the first 12 months of biologic therapy. The dosage of OCS tended to decrease in the older group and significantly decrease in the younger group. Conclusion Biologic therapy for older patients with asthma can be continued, with efficacy and safety similar to those in younger patients with asthma.
Collapse
Affiliation(s)
- Ryota Okazaki
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
| | - Tomoya Harada
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
| | - Yoshihiro Funaki
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
| | - Masato Morita
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
| | - Miki Takata
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
| | - Hiroki Kohno
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
| | - Hiroki Ishikawa
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
| | - Genki Inui
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
| | - Miyu Nishigami
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
| | - Mitsuhiro Yamamoto
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
| | - Aditya Sri Listyoko
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
- Pulmonary and Respiratory Medicine Department, Faculty of Medicine, Brawijaya University-Dr. Saiful Anwar General Hospital, Malang 65112, Indonesia
| | - Akira Yamasaki
- Division of Respiratory Medicine and Rheumatology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Tottori 683-8504, Japan
| |
Collapse
|
8
|
Alqarni AA, Aldhahir AM, Siraj RA, Alqahtani JS, Alghamdi DA, Alghamdi SK, Alamoudi AA, Mohtaseb MA, Majrshi M, AlGarni AA, Badr OI, Alwafi H. Asthma medication adherence, control, and psychological symptoms: a cross-sectional study. BMC Pulm Med 2024; 24:189. [PMID: 38641584 PMCID: PMC11031990 DOI: 10.1186/s12890-024-02995-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/03/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Nonadherence to therapies and psychological disorders are associated with poor asthma control. This study aims to assess the prevalence of anxiety and depressive symptoms, asthma control, and adherence to inhalers and to investigate whether there is an association of anxiety and depressive symptoms with adherence to inhalers and asthma control. METHODS We measured anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale in patients with asthma. Asthma Control Test and the 10-Item Test of Adherence to Inhalers Scale were used to assess levels of asthma control adherence to inhalers, respectively. Univariate and multivariate regression models assessed the associations of anxiety and depressive symptoms with adherence to inhalers and asthma control. RESULTS A total of 287 patients completed the study, of whom 72% were female. The mean ± SD age and body mass index of our study population were 44 ± 13 years and 29 ± 7.2 kg/m2, respectively. Poor adherence to inhaler use was highly prevalent (49.8%; 95% CI: 43.8 to 55.7). The prevalence of anxiety, depression and poor asthma control was 27.2% (95% CI: 22.1 to 32.7), 20.9% (95% CI: 16.3 to 26.1), and 22.7% (95% CI: 17.9 to 27.9), respectively. We found a negative relationship between asthma control and anxiety, and depressive symptoms (adjusted β: -0.25; 95% CI: -0.36 to -0.14; p < 0.001 and adjusted β: -0.29; 95% CI: -0.40 to -0.18; p < 0.001, respectively). A negative relationship was also observed between adherence to inhalers and anxiety and depressive symptoms (adjusted β: -0.34; 95% CI: -0.46 to -0.22; p < 0.001 and adjusted β: -0.36; 95% CI: - 0.48 to - 0.24; p < 0.001, respectively). CONCLUSIONS The high prevalence of uncontrolled asthma symptoms and poor adherence to inhalers and their impact on anxiety and depression levels among patients with asthma point to the need for early screening for psychological symptoms and recognition of nonadherence as part of asthma assessment and management plan in primary care in Saudi Arabia to avoid further worsening of asthma symptoms. Further studies are needed to explore the effectiveness of specific psychoeducational interventions and investigate the long-term impact of early psychological symptom detection on asthma outcomes.
Collapse
Affiliation(s)
- Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
- Respiratory Therapy Unit, King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Rayan A Siraj
- Department of Respiratory Care, College of Applied Medical Sciences, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Dana A Alghamdi
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Sarah K Alghamdi
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abeer A Alamoudi
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Majduleen A Mohtaseb
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mansour Majrshi
- National Heart and Lung Institute, Imperial College London, London, UK
- Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Abdulkareem A AlGarni
- King Abdulaziz Hospital, The Ministry of National Guard Health Affairs, Al Ahsa, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, College of Applied Medical Sciences, Al Ahsa, Saudi Arabia
| | - Omaima I Badr
- Department of Chest Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
- Department of Pulmonary Medicine, Al Noor Specialist Hospital, Mecca, Saudi Arabia
| | - Hassan Alwafi
- Department of Clinical Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| |
Collapse
|
9
|
Liu Y, Zhang Z, He Y, Li R, Zhang Y, Liu H, Wang Y, Ma W. Mitochondria protective and anti-apoptotic effects of peripheral benzodiazepine receptor and its ligands on the treatment of asthma in vitro and vivo. J Inflamm (Lond) 2024; 21:11. [PMID: 38641850 PMCID: PMC11031857 DOI: 10.1186/s12950-024-00383-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/03/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Asthma is a prevalent respiratory inflammatory disease. Abnormal apoptosis of bronchial epithelial cells is one of the major factors in the progression of asthma. Peripheral benzodiazepine receptors are highly expressed in bronchial epithelial cells, which act as a component of the mitochondrial permeability transition pore to regulate its opening and closing and apoptosis of bronchial epithelial cells. We aimed to investigate the mechanisms by which peripheral benzodiazepine receptor and its ligands, agonist 4'-Chlorodiazepam (Ro5-4864) and antagonist 1-(2-chlorophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquinolinecarboxamide (PK 11,195), modulate the mitochondrial function and cell apoptosis in the treatment of asthma. METHODS In vitro study, Ro5-4864 and PK 11,195 were utilized to pretreat cells prior to the inflammatory injury induced by Lipopolysaccharide. The reactive oxygen species, the apoptosis of cell, the mitochondrial membrane potentials, the ultrastructures of the mitochondria and the expression levels of peripheral benzodiazepine receptors and apoptosis-related proteins and genes were detected. In vivo study, mice were administrated intraperitoneally with Ro5-4864 and PK 11,195 before sensitized and challenged by ovalbumin. Serum IgE and bronchoalveolar lavage fluid cytokines were detected, and lung tissues were underwent the histopathological examination. RESULTS The ligands of peripheral benzodiazepine receptor counteracted the effects of the increase of reactive oxygen species, the elevated extent of apoptosis, the decrease of mitochondrial membrane potentials and the disruption of mitochondrial ultrastructures induced by Lipopolysaccharide. The ligands also promoted the expression of anti-apoptosis-related proteins and genes and inhibited the expression of pro-apoptosis-related proteins and genes. Besides, the ligands reduced the levels of serum IgE and bronchoalveolar lavage fluid cytokines in asthmatic mice and attenuated the histopathological damage of lungs. CONCLUSION Peripheral benzodiazepine receptor serves as a potential therapeutic target for the treatment of asthma, with its ligands exerting mitochondrial protective and anti-apoptotic effects on bronchial epithelial cells.
Collapse
Affiliation(s)
- Yurui Liu
- Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, 510405, Guangzhou, P.R. China
| | - Zhengze Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, 510405, Guangzhou, P.R. China
| | - Yuewen He
- Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, 510405, Guangzhou, P.R. China
| | - Ruogen Li
- Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, 510405, Guangzhou, P.R. China
| | - Yuhao Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, 510405, Guangzhou, P.R. China
| | - Hao Liu
- Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, 510405, Guangzhou, P.R. China
| | - Yong Wang
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, 510405, Guangzhou, P.R. China
| | - Wuhua Ma
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, 12 Jichang Road, 510405, Guangzhou, P.R. China.
| |
Collapse
|
10
|
Gao E, Radpavar I, Clark EJ, Ryan GW, Ross MK. Application of a user experience design approach for an EHR-based clinical decision support system. JAMIA Open 2024; 7:ooae019. [PMID: 38646110 PMCID: PMC11032728 DOI: 10.1093/jamiaopen/ooae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 01/17/2024] [Accepted: 03/09/2024] [Indexed: 04/23/2024] Open
Abstract
Objective We applied a user experience (UX) design approach to clinical decision support (CDS) tool development for the specific use case of pediatric asthma. Our objective was to understand physicians' workflows, decision-making processes, barriers (ie, pain points), and facilitators to increase usability of the tool. Materials and methods We used a mixed-methods approach with semi-structured interviews and surveys. The coded interviews were synthesized into physician-user journey maps (ie, visualization of a process to accomplish goals) and personas (ie, user types). Interviews were conducted via video. We developed physician journey maps and user personas informed by their goals, systems interactions, and experiences with pediatric asthma management. Results The physician end-user personas identified were: efficiency, relationship, and learning. Features of a potential asthma CDS tool sought varied by physician practice type and persona. It was important to the physician end-user that the asthma CDS tool demonstrate value by lowering workflow friction (ie, difficulty or obstacles), improving the environment surrounding physicians and patients, and using it as a teaching tool. Customizability versus standardization were important considerations for uptake. Discussion Different values and motivations of physicians influence their use and interaction with the EHR and CDS tools. These different perspectives can be captured by applying a UX design approach to the development process. For example, with the importance of customizability, one approach may be to build a core module with variations depending on end-user preference. Conclusion A UX approach can drive design to help understand physician-users and meet their needs; ultimately with the goal of increased uptake.
Collapse
Affiliation(s)
- Emily Gao
- College of Letters and Sciences, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Ilana Radpavar
- College of Letters and Sciences, University of California Los Angeles, Los Angeles, CA 90095, United States
| | - Emma J Clark
- Department of Pediatrics, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| | - Gery W Ryan
- Department of Health Systems Science, Kaiser Permanente, Bernard J. Tyson School of Medicine, Pasadena, CA 91101, United States
| | - Mindy K Ross
- Department of Pediatrics, University of California Los Angeles, David Geffen School of Medicine, Los Angeles, CA 90095, United States
| |
Collapse
|
11
|
Chen X, Wang X, Huang S, Luo W, Luo Z, Chen Z. Study on Predicting Clinical Stage of Patients with Bronchial Asthma Based on CT Radiomics. J Asthma Allergy 2024; 17:291-303. [PMID: 38562252 PMCID: PMC10982665 DOI: 10.2147/jaa.s448064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024] Open
Abstract
Objective To explore the value of a new model based on CT radiomics in predicting the staging of patients with bronchial asthma (BA). Methods Patients with BA from 2018 to 2021 were retrospectively analyzed and underwent plain chest CT before treatment. According to the guidelines for the prevention and treatment of BA (2016 edition), they were divided into two groups: acute attack and non-acute attack. The images were processed as follows: using Lung Kit software for image standardization and segmentation, using AK software for image feature extraction, and using R language for data analysis and model construction (training set: test set = 7: 3). The efficacy and clinical effects of the constructed model were evaluated with ROC curve, sensitivity, specificity, calibration curve and decision curve. Results A total of 112 patients with BA were enrolled, including 80 patients with acute attack (range: 2-86 years old, mean: 53.89±17.306 years old, males of 33) and 32 patients with non-acute attack (range: 4-79 years old, mean: 57.38±19.223 years old, males of 18). A total of 10 imaging features are finally retained and used to construct model using multi-factor logical regression method. In the training group, the AUC, sensitivity and specificity of the model was 0.881 (95% CI:0.808-0.955), 0.804 and 0.818, separately; while in the test group, it was 0.792 (95% CI:0.608-0.976), 0.792 and 0.80, respectively. Conclusion The model constructed based on radiomics has a good effect on predicting the staging of patients with BA, which provides a new method for clinical diagnosis of staging in BA patients.
Collapse
Affiliation(s)
- Xiaodong Chen
- Radiology Imaging Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang City, People’s Republic of China
| | - Xiangyuan Wang
- Radiology Imaging Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang City, People’s Republic of China
| | - Shangqing Huang
- Radiology Imaging Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang City, People’s Republic of China
| | - Wenxuan Luo
- Radiology Imaging Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang City, People’s Republic of China
| | - Zebin Luo
- Radiology Imaging Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang City, People’s Republic of China
| | - Zipan Chen
- Health Management Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang City, People’s Republic of China
| |
Collapse
|
12
|
He P, Hao J, Kong LF, Wotan A, Yan P, Geng YC, Wang Y, Li ZY, Hu SX, Ren B, Rong XJ, Tie C. Resolvin and lipoxin metabolism network regulated by Hyssopus Cuspidatus Boriss extract in asthmatic mice. Prostaglandins Other Lipid Mediat 2024; 170:106803. [PMID: 38040190 DOI: 10.1016/j.prostaglandins.2023.106803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/07/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
Resolvin (Rv) and lipoxin (Lx) play important regulative roles in the development of several inflammation-related diseases. The dysregulation of their metabolic network is believed to be closely related to the occurrence and development of asthma. The Hyssopus Cuspidatus Boriss extract (SXCF) has long been used as a treatment for asthma, while the mechanism of anti-inflammatory and anti-asthma action targeting Rv and Lx has not been thoroughly investigated. In this study, we aimed to investigate the effects of SXCF on Rv, Lx in ovalbumin (OVA)-sensitized asthmatic mice. The changes of Rv, Lx before and after drug administration were analyzed based on high sensitivity chromatography-multiple response monitoring (UHPLC-MRM) analysis and multivariate statistics. The pathology exploration included behavioral changes of mice, IgE in serum, cytokines in BALF, and lung tissue sections stained with H&E. It was found that SXCF significantly modulated the metabolic disturbance of Rv, Lx due to asthma. Its modulation effect was significantly better than that of dexamethasone and rosmarinic acid which is the first-line clinical medicine and the main component of Hyssopus Cuspidatus Boriss, respectively. SXCF is demonstrated to be a potential anti-asthmatic drug with significant disease-modifying effects on OVA-induced asthma. The modulation of Rv and Lx is a possible underlying mechanism of the SXCF effects.
Collapse
Affiliation(s)
- Ping He
- State Key Laboratory for Fine Exploration and Intelligent Development of Coal Resources, China University of Mining and Technology-Beijing, Beijing, China; School of Chemical and Environmental Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Juan Hao
- Xinjiang Huachun Biological Pharmaceutical Co., Urumqi, China
| | - Ling-Fei Kong
- State Key Laboratory for Fine Exploration and Intelligent Development of Coal Resources, China University of Mining and Technology-Beijing, Beijing, China; School of Chemical and Environmental Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Ayidana Wotan
- Xinjiang Institute of Material Medica, Urumqi, China
| | - Pan Yan
- State Key Laboratory for Fine Exploration and Intelligent Development of Coal Resources, China University of Mining and Technology-Beijing, Beijing, China; School of Chemical and Environmental Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Yi-Cong Geng
- State Key Laboratory for Fine Exploration and Intelligent Development of Coal Resources, China University of Mining and Technology-Beijing, Beijing, China; School of Chemical and Environmental Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Yi Wang
- State Key Laboratory for Fine Exploration and Intelligent Development of Coal Resources, China University of Mining and Technology-Beijing, Beijing, China; School of Chemical and Environmental Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Zheng-Ying Li
- State Key Laboratory for Fine Exploration and Intelligent Development of Coal Resources, China University of Mining and Technology-Beijing, Beijing, China; School of Chemical and Environmental Engineering, China University of Mining and Technology-Beijing, Beijing, China
| | - Shi-Xian Hu
- Xinjiang Huachun Biological Pharmaceutical Co., Urumqi, China
| | - Bin Ren
- Xinjiang Huachun Biological Pharmaceutical Co., Urumqi, China
| | | | - Cai Tie
- State Key Laboratory for Fine Exploration and Intelligent Development of Coal Resources, China University of Mining and Technology-Beijing, Beijing, China; School of Chemical and Environmental Engineering, China University of Mining and Technology-Beijing, Beijing, China.
| |
Collapse
|
13
|
Martínez-García MA, Olveira C, Girón R, García-Clemente M, Máiz L, Sibila O, Golpe R, Rodríguez-Hermosa JL, Barreiro E, Méndez R, Prados C, Rodríguez-López J, Oscullo G, de la Rosa D. Reliability of blood eosinophil count in steady-state bronchiectasis. Pulmonology 2024:S2531-0437(23)00204-0. [PMID: 38182470 DOI: 10.1016/j.pulmoe.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/14/2023] [Accepted: 11/21/2023] [Indexed: 01/07/2024] Open
Abstract
RATIONALE The baseline value of eosinophils in peripheral blood (BEC) has been associated with different degrees of severity, prognosis and response to treatment in patients with bronchiectasis. It is not known, however, if this basal value remains constant over time. OBJECTIVES The aim of this study was to assess whether the BEC remains stable in the long term in patients with bronchiectasis. METHODS AND MEASUREMENTS Patients from the RIBRON registry of bronchiectasis diagnosed by computed tomography with at least 2 BEC measurements one year apart were included in the study. Patients with asthma and those taking anti-eosinophilic drugs were excluded. Reliability was assessed using the intra-class correlation coefficient (ICC). A patient with a BEC of at least 300 cells/uL or less than 100 cells/uL was considered eosinophilic or eosinopenic, respectively. Group changes over time were also calculated. MAIN RESULTS Seven hundred and thirteen patients were finally included, with a mean age of 66.5 (13.2) years (65.8 % women). A total of 2701 BEC measurements were performed, with a median number of measurements per patient of 4 (IQR: 2-5) separated by a median of 12.1 (IQR: 10.5-14.3) months between two consecutive measurements. The ICC was good (>0.75) when calculated between two consecutive measurements (approximately one year apart) but had dropped significantly by the time of the next annual measurements. Similarly, the change from an eosinophilic or eosinopenic patient to a non-eosinophilic or non-eosinopenic patient, respectively, was less than 30 % during the first year with respect to the baseline value but was close to 50 % in later measurements. CONCLUSIONS Given the significant changes observed in the baseline value of the BEC over time, its monitoring is necessary in patients with bronchiectasis in order to more reliably assess its usefulness.
Collapse
Affiliation(s)
- M A Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias. ISCIII. Madrid. Spain.
| | - C Olveira
- Servicio de Neumología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, Spain
| | - R Girón
- Servicio de Neumología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | - M García-Clemente
- Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - L Máiz
- Servicio de Neumología, Hospital Ramón y Cajal, Madrid, Spain
| | - O Sibila
- Servicio de Neumología, Hospital Clínico, Barcelona, Spain
| | - R Golpe
- Servicio de Neumología, Hospital Lucus Augusti, Lugo, Spain
| | | | - E Barreiro
- Servicio de Neumología, Hospital del Mar-IMIM, UPF, CIBERES, Barcelona, Spain; CIBERES de Enfermedades Respiratorias. ISCIII. Madrid. Spain
| | - Raúl Méndez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias. ISCIII. Madrid. Spain
| | - C Prados
- Servicio de Neumología, Hospital La Paz, Madrid, Spain
| | - J Rodríguez-López
- Servicio de Neumología, Hospital San Agustín, Avilés, Asturias, Spain
| | - G Oscullo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - D de la Rosa
- Servicio de Neumología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|
14
|
Hostrup M, Jessen S. Beyond bronchodilation: Illuminating the performance benefits of inhaled beta 2 -agonists in sports. Scand J Med Sci Sports 2024; 34:e14567. [PMID: 38268072 DOI: 10.1111/sms.14567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/29/2023] [Accepted: 01/06/2024] [Indexed: 01/26/2024]
Abstract
Given the prevalent use of inhaled beta2 -agonists in sports, there is an ongoing debate as to whether they enhance athletic performance. Over the last decades, inhaled beta2 -agonists have been claimed not to enhance performance with little consideration of dose or exercise modality. In contrast, orally administered beta2 -agonists are perceived as being performance enhancing, predominantly on muscle strength and sprint ability, but can also induce muscle hypertrophy and slow-to-fast fiber phenotypic switching. But because inhaled beta2 -agonists are more efficient to achieve high systemic concentrations than oral delivery relative to dose, it follows that the inhaled route has the potential to enhance performance too. The question is at which inhaled doses such effects occur. While supratherapeutic doses of inhaled beta2 -agonists enhance muscle strength and short intense exercise performance, effects at low therapeutic doses are less apparent. However, even high therapeutic inhaled doses of commonly used beta2 -agonists have been shown to induce muscle hypertrophy and to enhance sprint performance. This is concerning from an anti-doping perspective. In this paper, we raise awareness of the circumstances under which inhaled beta2 -agonists can constitute a performance-enhancing benefit.
Collapse
Affiliation(s)
- Morten Hostrup
- Department of Nutrition, Exercise and Sports, The August Krogh Section for Human Physiology, University of Copenhagen, Copenhagen, Denmark
| | - Søren Jessen
- Department of Nutrition, Exercise and Sports, The August Krogh Section for Human Physiology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
15
|
Hostrup M, Hansen ESH, Rasmussen SM, Jessen S, Backer V. Asthma and exercise-induced bronchoconstriction in athletes: Diagnosis, treatment, and anti-doping challenges. Scand J Med Sci Sports 2024; 34:e14358. [PMID: 36965010 DOI: 10.1111/sms.14358] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 02/14/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023]
Abstract
Athletes often experience lower airway dysfunction, such as asthma and exercise-induced bronchoconstriction (EIB), which affects more than half the athletes in some sports, not least in endurance sports. Symptoms include coughing, wheezing, and breathlessness, alongside airway narrowing, hyperresponsiveness, and inflammation. Early diagnosis and management are essential. Not only because untreated or poorly managed asthma and EIB potentially affects competition performance and training, but also because untreated airway inflammation can result in airway epithelial damage, remodeling, and fibrosis. Asthma and EIB do not hinder performance, as advancements in treatment strategies have made it possible for affected athletes to compete at the highest level. However, practitioners and athletes must ensure that the treatment complies with general guidelines and anti-doping regulations to prevent the risk of a doping sanction because of inadvertently exceeding specified dosing limits. In this review, we describe considerations and challenges in diagnosing and managing athletes with asthma and EIB. We also discuss challenges facing athletes with asthma and EIB, while also being subject to anti-doping regulations.
Collapse
Affiliation(s)
- Morten Hostrup
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Erik S H Hansen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
| | - Søren M Rasmussen
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Medical Department, Nykøbing Falster Hospital, Nykøbing Falster, Denmark
| | - Søren Jessen
- The August Krogh Section, Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Rigshospitalet, Copenhagen, Denmark
- Department of Otorhinolaryngology Head & Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| |
Collapse
|
16
|
Oscullo G, Gomez-Olivas JD, Martínez-García MÁ. Eosinophilic bronchiectasis and therapeutic opportunities. Ann Allergy Asthma Immunol 2023; 131:689-690. [PMID: 37741495 DOI: 10.1016/j.anai.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/25/2023]
Affiliation(s)
- Grace Oscullo
- Pneumology Department, Polytechnic and University La Fe Hospital, Valencia, Spain
| | | | - Miguel Ángel Martínez-García
- Pneumology Department, Polytechnic and University La Fe Hospital, Valencia, Spain; CIBERES of Pulmonary Diseases, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| |
Collapse
|
17
|
Gong C, Pan L, Jiang Y, Sun Y, Han Y, Wang D, Wang Y. Investigating the mechanism of action of Yanghe Pingchuan Granule in the treatment of bronchial asthma based on bioinformatics and experimental validation. Heliyon 2023; 9:e21936. [PMID: 38027735 PMCID: PMC10654227 DOI: 10.1016/j.heliyon.2023.e21936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Yanghe Pingchuan Granule (YPG) is a patented Chinese medicine developed independently by the Anhui Provincial Hospital of Traditional Chinese Medicine. For many years, it has been used for the treatment of asthma with remarkable clinical effects. However, the composition of YPG is complex, and its potential active ingredients and mechanism of action for the treatment of asthma are unknown. Materials and methods In this study, we investigated the potential mechanism of action of YPG in the treatment of asthma through a combination of bioinformatics and in vivo experimental validation. We searched for active compounds in YPG and asthma targets from multiple databases and obtained common targets. Subsequently, a protein-protein interaction (PPI) network for compound disease was constructed using the protein interaction database for Gene Ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Finally, hematoxylin and eosin (H&E) staining, Masson staining, enzyme-linked immunosorbent assay (ELISA) analysis, immunofluorescence (IF) experiments, and Western blot (WB) experiments were performed to verify the possible mechanism of action of YPG for asthma treatment. Results We obtained 72 active ingredients and 318 drug target genes that overlap with asthma. Serine/threonine-protein kinase (AKT1), tumor protein p53 (TP53), tumor necrosis factor (TNF), interleukin (IL)-6, IL-1β, vascular endothelial growth factor-A (VEGFA), prostaglandin-endoperoxide synthase 2 (PTGS2), caspase-3 (CASP3), mitogen-activated protein kinase 3 (MAPK3) and epidermal growth factor receptor (EGFR) were the most relevant genes in the PPI network. KEGG analysis showed a high number of genes enriched for the nuclear factor kappa-B (NF-κB) signaling pathway. Animal experiments confirmed that YPG reduced inflammatory cell infiltration and down-regulated the expression of ovalbumin-induced inflammatory factors. Furthermore, YPG treatment decreased the protein expression of NFĸB1, nuclear factor kappa B kinase subunit beta (IKBKB), vascular endothelial growth factor (VEGF), and vascular endothelial growth factor receptor 2 (VEGFR2) in lung tissue. Conclusion YPG has a positive effect on asthma by interfering with multiple targets. Furthermore, YPG may significantly inhibit the follicle-induced inflammatory response through the NF-ĸB signaling pathway.
Collapse
Affiliation(s)
- Chunxia Gong
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, China
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei, Anhui, 230038, China
| | - Lingyu Pan
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, China
| | - Yeke Jiang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, China
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei, Anhui, 230038, China
| | - Yehong Sun
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, China
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei, Anhui, 230038, China
| | - Yanquan Han
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, China
| | - Dianlei Wang
- College of Pharmacy, Anhui University of Chinese Medicine, Hefei, Anhui, 230038, China
| | - Yongzhong Wang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui, 230031, China
| |
Collapse
|
18
|
Martínez-García MÁ, Oscullo G, Gomez-Olivas JD. Peripheral cellular biomarkers in bronchiectasis. Respir Med Res 2023; 84:101063. [PMID: 38029651 DOI: 10.1016/j.resmer.2023.101063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/29/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERES de Enfermedades Respiratorias, ISCIII, Madrid, Spain.
| | - Grace Oscullo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | |
Collapse
|
19
|
Yuan F, Yang Y, Liu L, Zhou P, Zhu Y, Chai Y, Chen K, Tang W, Huang Q, Zhang C. Research progress on the mechanism of astragaloside IV in the treatment of asthma. Heliyon 2023; 9:e22149. [PMID: 38045181 PMCID: PMC10692808 DOI: 10.1016/j.heliyon.2023.e22149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 12/05/2023] Open
Abstract
Asthma is a common chronic respiratory disease, and its treatment is a core problem and challenge in clinical practice. Glucocorticoids (GCs) are the first-line therapy for the treatment of asthma. Local and systemic adverse reactions caused by GCs create obstacles to the treatment of asthma. Therefore, the research target is to find a new, safe, and effective therapeutic medicine at present. Natural products are an important source for treating asthma with low cost and low toxicity. Astragaloside IV (AS-IV) is an active ingredient of traditional Chinese medicine Astragalus mongholicus Bunge. Previous studies have indicated that AS-IV plays a therapeutic role in the treatment of asthma by inhibiting airway inflammation and remodeling the airway, and by regulating immunity and neuroendocrine function (Fig. 1) . It has a variety of biological characteristics such as multi-target intervention, high safety, and good curative effect. This article reviews the specific mechanism of AS-IV for the treatment of asthma to provide references for subsequent research.
Collapse
Affiliation(s)
- Fanyi Yuan
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yang Yang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Li Liu
- Department of Pharmacy, Hospital of Chengdu university of Traditional Chinese Medicine, Chengdu, China
| | - Pengcheng Zhou
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Zhu
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yilu Chai
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Keling Chen
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wenjun Tang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qingsong Huang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chuantao Zhang
- Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
20
|
Lee E, Rhee EH, Kim K, Kim HS, Kim WK, Song DJ, Park JS, Yoo Y, Suh DI, Jung S, Yoon JS, Lee SW, Kim JT, Lim DH, Baek HS, Shin M, Kwon JW, Jang GC, Seo JH, Woo SI, Kim HY, Shin YH, Lee JS, Yang HJ, Yu J. Frequency of exacerbation and degree of required asthma medication can characterize childhood longitudinal asthma trajectories. Ann Allergy Asthma Immunol 2023; 131:444-450. [PMID: 37302526 DOI: 10.1016/j.anai.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND To the best of our knowledge, there have been no investigations of longitudinal asthma trajectories based on asthma exacerbation frequency and medications required for asthma control in children. OBJECTIVE To investigate longitudinal asthma trajectories based on the exacerbation frequency throughout childhood and asthma medication ranks. METHODS A total of 531 children aged 7 to 10 years were enrolled from the Korean childhood Asthma Study. Required asthma medications for control of asthma from 6 to 12 years of age and asthma exacerbation frequency from birth to 12 years of age were obtained from the Korean National Health Insurance System database. Longitudinal asthma trajectories were identified on the basis of asthma exacerbation frequency and asthma medication ranks. RESULTS Four asthma clusters were identified: lesser exacerbation with low-step treatment (8.1%), lesser exacerbations with middle-step treatment (30.7%), highly frequent exacerbations in early childhood with small-airway dysfunction (5.7%), and frequent exacerbations with high-step treatment (55.6%). The frequent exacerbations with high-step treatment cluster were characterized by a high prevalence of male sex, increased blood eosinophil (counts) with fractional exhaled nitric oxide, and high prevalence of comorbidities. The highly frequent exacerbation in early childhood with small-airway dysfunction cluster was characterized by recurrent wheeze in preschool age, with high prevalence of acute bronchiolitis in infancy and a greater number of family members with small-airway dysfunction at school age. CONCLUSION The present study identified 4 longitudinal asthma trajectories on the basis of the frequency of asthma exacerbation and asthma medication ranks. These results would help clarify the heterogeneities and pathophysiologies of childhood asthma.
Collapse
Affiliation(s)
- Eun Lee
- Department of Pediatrics, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Eun Hee Rhee
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Kyunghoon Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hwan Soo Kim
- Department of Pediatrics, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Ji Soo Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Yoo
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sungsu Jung
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ji-Sun Yoon
- Department of Pediatrics, Chung-Ang University Gwang-Myeong Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Jin Tack Kim
- Department of Pediatrics, School of Medicine, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Seoul, Republic of Korea
| | - Dae Hyun Lim
- Department of Pediatrics, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Hey Sung Baek
- Department of Pediatrics, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University School of Medicine, Bucheon, Republic of Korea
| | - Ji Won Kwon
- Department of Pediatrics, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Ilsan, Republic of Korea
| | - Ju Hee Seo
- Department of Pediatrics, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Sung Il Woo
- Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Hyung Young Kim
- Department of Pediatrics, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Youn Ho Shin
- Department of Pediatrics, Gangnam CHA Medical Center, CHA University School of Medicine, Seoul, Republic of Korea
| | - Ju Suk Lee
- Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Hyeon-Jong Yang
- Department of Pediatrics, Pediatric Allergy and Respiratory Center, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
| | - Jinho Yu
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
21
|
Martínez-García MÁ, Méndez R, Olveira C, Girón R, García-Clemente M, Máiz L, Sibila O, Golpe R, Rodríguez-Hermosa JL, Barreiro E, Prados C, Rodríguez-López J, Oscullo G, Labarca G, de la Rosa D. The U-Shaped Relationship Between Eosinophil Count and Bronchiectasis Severity: The Effect of Inhaled Corticosteroids. Chest 2023; 164:606-613. [PMID: 37088355 DOI: 10.1016/j.chest.2023.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Although a proven relationship exists between the blood eosinophil count (BEC) and the severity of both asthma and COPD, its relationship with bronchiectasis has not been well established. The objective of this study was to analyze the relationship between BEC and the number and severity of exacerbations, and patients' responses to inhaled corticosteroid (IC) treatment in bronchiectasis RESEARCH QUESTION: Does an association exist among BEC, the number of exacerbations and severity of bronchiectasis, and IC treatment? STUDY DESIGN AND METHODS This was a multicenter (43 centers) prospective observational study derived from the Spanish Bronchiectasis Registry. Patients with proven bronchiectasis and a known BEC were included, whereas those with asthma or antieosinophilic treatments were excluded. Patients were divided into four groups according to the BEC at the time of inclusion in the study in a steady-state situation: (1) eosinopenic bronchiectasis (< 50 eosinophils/μL), (2) low number of eosinophils (51-100/μL), (3) normal number of eosinophils (101-300/μL), and (4) eosinophilic bronchiectasis (> 300 eosinophils/μL). RESULTS Nine hundred twenty-eight patients finally were included: 123 patients (13.3%) with < 50 eosinophils/μL (eosinopenic group), 164 patients (17.7%) with 50-100 eosinophils/μL, 488 patients (52.6%) with 101-300 eosinophils/μL, and 153 patients (16.5%) with > 300 eosinophils/μL (eosinophilic group). BEC showed a significant U-shaped relationship with severity, exacerbations, lung function, microbiologic profile, and IC treatment (these being higher in the eosinopenic group compared with the eosinophilic group). IC treatment significantly decreased the number and severity of exacerbations only in the group of bronchiectasis patients with > 300 eosinophils/μL. INTERPRETATION A significant U-shaped relationship was found between BEC and severity and exacerbations in bronchiectasis that was more pronounced in the eosinopenic group. IC treatment decreased the number and severity of exacerbations only in the eosinophilic group.
Collapse
Affiliation(s)
- Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias, ISCIII, Madrid, Spain.
| | - Raúl Méndez
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias, ISCIII, Madrid, Spain
| | - Casilda Olveira
- Servicio de Neumología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA)/Universidad de Málaga, Málaga, Spain
| | - Rosa Girón
- Servicio de Neumología, Instituto de Investigación Sanitaria, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Luis Máiz
- Servicio de Neumología, Hospital Ramón y Cajal, Madrid, Spain
| | - Oriol Sibila
- Servicio de Neumología, Hospital Clínico, Barcelona, Spain
| | - Rafael Golpe
- Servicio de Neumología, Hospital Lucus Augusti, Lugo, Spain
| | | | - Esther Barreiro
- CIBERES de Enfermedades Respiratorias, ISCIII, Madrid, Spain; Servicio de Neumología, Hospital del Mar-IMIM, UPF, CIBERES, Barcelona, Spain
| | | | | | - Grace Oscullo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Gonzalo Labarca
- Division of Sleep Medicine, Harvard Medical School, Boston, MA; Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, Concepción, Chile
| | - David de la Rosa
- Servicio de Neumología, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| |
Collapse
|
22
|
Gozal D, Gomez-Olivas JD, Martínez-García MÁ, Oscullo G. Do Inhaled Corticosteroids Increase the Risk of Obstructive Sleep Apnea? Arch Bronconeumol 2023; 59:553-555. [PMID: 37495444 DOI: 10.1016/j.arbres.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/28/2023]
Affiliation(s)
- David Gozal
- Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, United States.
| | | | - Miguel Ángel Martínez-García
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain; CIBERES de Enfermedades Respiratorias, ISCIII, Madrid, Spain
| | - Grace Oscullo
- Servicio de Neumología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| |
Collapse
|
23
|
Lopez-Campos JL, Reinoso-Arija R, Ferrer Galván M, Romero Falcón A, Alvarez-Gutiérrez FJ, Ortega-Ruiz F, Quintana-Gallego E. Evaluation of Different Doses in Inhaled Therapy: A Comprehensive Analysis. Pharmaceutics 2023; 15:2206. [PMID: 37765175 PMCID: PMC10535234 DOI: 10.3390/pharmaceutics15092206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Currently, there is a considerable degree of confusion over the dosage of inhaled medications. Here, we carried out a review of all the doses used for the devices used in inhalation therapy. METHODS We first performed a systematic search of the different inhalation devices included on the July 2023 Spanish Ministry of Health Billing List. We then consulted the Spanish Agency for Medicines and Health Products to find the updated official label and to obtain the information on the exact composition. RESULTS We identified 90 unique products, of which 22 were long-acting bronchodilators (and combinations thereof) and 68 were products containing inhaled corticosteroids (ICS). Overall, 10 products with bronchodilators and 40 with ICS were marketed with the metered dose, while 11 with bronchodilators and 28 with ICS were marketed with the delivered dose. In addition, in some bronchodilators, the drug was referred to as a type of salt, whereas in others the information referred to the drug itself. CONCLUSIONS Our data show that for each inhaled drug there may be up to four different doses and that the marketed name may refer to any of these. Clinicians must be aware of these different dosages when prescribing inhaled medications.
Collapse
Affiliation(s)
- José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Seville, Spain; (R.R.-A.); (M.F.G.); (A.R.F.); (F.J.A.-G.); (F.O.-R.); (E.Q.-G.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Rocio Reinoso-Arija
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Seville, Spain; (R.R.-A.); (M.F.G.); (A.R.F.); (F.J.A.-G.); (F.O.-R.); (E.Q.-G.)
| | - Marta Ferrer Galván
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Seville, Spain; (R.R.-A.); (M.F.G.); (A.R.F.); (F.J.A.-G.); (F.O.-R.); (E.Q.-G.)
| | - Auxiliadora Romero Falcón
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Seville, Spain; (R.R.-A.); (M.F.G.); (A.R.F.); (F.J.A.-G.); (F.O.-R.); (E.Q.-G.)
| | - Francisco J. Alvarez-Gutiérrez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Seville, Spain; (R.R.-A.); (M.F.G.); (A.R.F.); (F.J.A.-G.); (F.O.-R.); (E.Q.-G.)
| | - Francisco Ortega-Ruiz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Seville, Spain; (R.R.-A.); (M.F.G.); (A.R.F.); (F.J.A.-G.); (F.O.-R.); (E.Q.-G.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Esther Quintana-Gallego
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Seville, Spain; (R.R.-A.); (M.F.G.); (A.R.F.); (F.J.A.-G.); (F.O.-R.); (E.Q.-G.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| |
Collapse
|
24
|
Martinez-Garcia MA. Inhaled Corticosteroids and Bronchiectasis: Friend or Foe? J Clin Med 2023; 12:jcm12093322. [PMID: 37176763 PMCID: PMC10178957 DOI: 10.3390/jcm12093322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 04/09/2023] [Indexed: 05/15/2023] Open
Abstract
The three most common chronic inflammatory airway diseases are asthma, chronic obstructive pulmonary disease (COPD), and bronchiectasis [...].
Collapse
Affiliation(s)
- Miguel Angel Martinez-Garcia
- Servicio de Neumología, Hospital Universitario y Politécnico la Fe de Valencia, 46026 Valencia, Spain
- CIBERES de Enfermedades Respiratorias, ISCIII, 28222 Madrid, Spain
- Pneumology Department, Hospital Universitario y Politécnico la Fe, Avenida Fernando Abril Martorell, 46012 Valencia, Spain
| |
Collapse
|
25
|
Li Q, Abdulla R, Xin X, Xue G, Kang X, Zhao F, Asia HA. Profiling of chemical constituents of Matricarla chamomilla L. by UHPLC-Q-Orbitrap-HRMS and in vivo evaluation its anti-asthmatic activity. Heliyon 2023; 9:e15470. [PMID: 37153405 PMCID: PMC10160356 DOI: 10.1016/j.heliyon.2023.e15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023] Open
Abstract
Matricarla chamomilla L. is native to European countries and widely cultivated in China, especially in Xinjiang. It has been used in Uygur medicine for the treatment of cough caused by asthma. In this study, UHPLC-Q-Orbitrap-MS was used to detect and identify the components from the active fraction of M. Chamomile, 64 compounds were identified by combining the standards, related literatures and mass spectrometry fragments, including 10 caffeoyl quinic acids, 38 flavonoids, 8 coumarins, 5 alkaloids and 3 other compounds. Furtherly, the anti-asthma activity of active fraction of M. Chamomile was investigated in OVA-induced allergic asthma rat model. The results showed that the number of EOS in Penh and bronchoalveolar lavage fluid (BALF) in the group of the active fraction of M. Chamomile was significantly lower than that in the model group. Besides, the active fraction of M. Chamomile can significantly reduce the IgE level and increased glutathione peroxidase (GSH-Px) in the serum of OVA-induced rats, and ameliorated OVA-induced lung injury. Hence, M. Chamomile could be used to treat asthma through their in vivo antioxidant and anti-inflammatory effects. This study explored the potential material basis of M. Chamomile for the treatment of asthma.
Collapse
Affiliation(s)
- Qian Li
- Department of Medicine Research, Hospital of Chinese Medicine Affiliated to Xinjiang Medical University, Urumqi, 830000, People's Republic of China
- Xinjiang Key Laboratory of Processing and Research of Traditional Chinese Medicine, Urumqi, 830000, People's Republic of China
- CAS Key Laboratory of Chemistry of Plant Resources in Arid Regions, Key Laboratory of Xinjiang Indigenous Medicinal Plants Resource Utilization, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, 40-1, Beijing Road, Urumqi, 830011, Xinjiang, China
- Corresponding author. Department of Medicine Research, Hospital of Chinese Medicine Affiliated to Xinjiang Medical University Urumqi, 830000, People's Republic of China.
| | - Rahima Abdulla
- CAS Key Laboratory of Chemistry of Plant Resources in Arid Regions, Key Laboratory of Xinjiang Indigenous Medicinal Plants Resource Utilization, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, 40-1, Beijing Road, Urumqi, 830011, Xinjiang, China
| | - Xuelei Xin
- CAS Key Laboratory of Chemistry of Plant Resources in Arid Regions, Key Laboratory of Xinjiang Indigenous Medicinal Plants Resource Utilization, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, 40-1, Beijing Road, Urumqi, 830011, Xinjiang, China
| | - Guipeng Xue
- Xinjiang Uygur Autonomous Region Evaluation and Inspection Center for Drug, Urumqi, 830000, People's Republic of China
| | - Xiaolong Kang
- Department of Medicine Research, Hospital of Chinese Medicine Affiliated to Xinjiang Medical University, Urumqi, 830000, People's Republic of China
- Xinjiang Key Laboratory of Processing and Research of Traditional Chinese Medicine, Urumqi, 830000, People's Republic of China
| | - Feicui Zhao
- Department of Medicine Research, Hospital of Chinese Medicine Affiliated to Xinjiang Medical University, Urumqi, 830000, People's Republic of China
- Xinjiang Key Laboratory of Processing and Research of Traditional Chinese Medicine, Urumqi, 830000, People's Republic of China
| | - Haji Akber Asia
- CAS Key Laboratory of Chemistry of Plant Resources in Arid Regions, Key Laboratory of Xinjiang Indigenous Medicinal Plants Resource Utilization, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, 40-1, Beijing Road, Urumqi, 830011, Xinjiang, China
- Corresponding author.
| |
Collapse
|
26
|
Radparvar I, Ross MK. Barriers and facilitators of electronic patient portal uptake for asthma management. J Asthma 2023; 60:635-646. [PMID: 35726134 PMCID: PMC9763543 DOI: 10.1080/02770903.2022.2087190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/28/2022] [Accepted: 06/04/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE An active patient-practitioner partnership is a key aspect of asthma management and patient-reported data helps with shared decision making. Technological advances such as the electronic patient portal can facilitate partnership, with the goal of improved asthma outcomes. However, uptake of portals by end-users for asthma management has been low. We studied portal-based asthma interventions to understand barriers and facilitators to its use. DATA SOURCES We searched within the PubMed, Web of Science, Scopus, MEDLINE, and Google Scholar databases. STUDY SELECTIONS We used the PRISMA extension for scoping reviews to guide our analysis of studies related to asthma and patient portals. We summarized relevant studies in terms of barriers and facilitators as well as study characteristics. RESULTS Sixteen studies were included in our final analysis. Common barriers to patient portal use for asthma management were lack of perceived value by the end-user, low end-user technological literacy, and limited resources. Facilitators of portal use included ease of use, personalization, and adequate technical support. Patient portals in these studies were used for a variety of applications related to core asthma management concepts of assessment and monitoring, education for a partnership in asthma care, environmental factors, co-morbidities, and medications. CONCLUSIONS Patient portal use for asthma management can be encouraged by ensuring the portal is easy to access and navigate, demonstrates values, as well as has readily available technical support. Involving end-users closely in the design process and implementation may help address barriers. Special attention is needed for groups with technological resource limitations.
Collapse
Affiliation(s)
- Ilana Radparvar
- College of Letters and Science, University of California Los Angeles, Los Angeles, CA, USA
| | - Mindy K. Ross
- University Of California Los Angeles, David Geffen School of Medicine, Department of Pediatrics, Los Angeles, CA, USA
| |
Collapse
|
27
|
Abstract
PURPOSE OF REVIEW With the improvement in device technology and delivery methods of inhaled medications, along with development of novel compounds and recognition of the importance of personalized approach in the management of chronic airway diseases, nebulizers have not only maintained their place in the treatment hierarchy of airway disease but have also proven a vital platform for the development of new classes of drugs. RECENT FINDINGS This short review explores recent advances in nebulized drug delivery in chronic obstructive pulmonary disease and other chronic airway diseases, emphasizing the progress in nebulizer technology, physiologic advantages of nebulized drug delivery and the high versatility of currently available and developing nebulizer-delivered pharmacotherapies. SUMMARY Versatility and efficiency of nebulizers allows for a broad spectrum of existing and novel therapies to be clinically studied, facilitating the progress in phenotype-targeted pharmacotherapies in the management of chronic airway diseases.
Collapse
|
28
|
de Araújo Gueiros Lira GV, Pontes da Silva GA, Sarinho ESC. Caregiver's sense of coherence and adherence to paediatric asthma treatment. Paediatr Respir Rev 2023; 45:45-51. [PMID: 36842951 DOI: 10.1016/j.prrv.2022.05.001] [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: 03/28/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
Abstract
Asthma is a chronic respiratory condition that needs to be well controlled to avoid compromising patients' quality of life. In the paediatric population, the role of caregivers is essential in this process. Moreover, adequate asthma control is integral to a child's emotional well-being and to improving the child's ability to participate fully in family and social life. One of the main reasons for uncontrolled asthma is low adherence to treatment, by patients and caregivers. Identifying factors mediating the involvement and participation of caregivers through evaluations of caregivers' sense of coherence can help in the adoption of strategies aimed at effectively directing adherence behaviour through educational and motivational interventions. The goal of this review article is to provide an overview of the sense of coherence as a construct of Antonovsky's salutogenic theory, and to identify its role as a key piece in the successful management of asthma in children.
Collapse
Affiliation(s)
- Georgia Véras de Araújo Gueiros Lira
- Allergy and Immunology Research Centre, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Paediatrics, Medical Sciences Centre, Federal University of Pernambuco, Recife, Brazil; Graduate Program in Child and Adolescent Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
| | - Giselia Alves Pontes da Silva
- Department of Paediatrics, Medical Sciences Centre, Federal University of Pernambuco, Recife, Brazil; Graduate Program in Child and Adolescent Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Emanuel Sávio Cavalcanti Sarinho
- Allergy and Immunology Research Centre, Federal University of Pernambuco, Recife, Pernambuco, Brazil; Department of Paediatrics, Medical Sciences Centre, Federal University of Pernambuco, Recife, Brazil; Graduate Program in Child and Adolescent Health, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| |
Collapse
|
29
|
Prevalence of Overweight and Obesity and Their Impact on Spirometry Parameters in Patients with Asthma: A Multicentre, Retrospective Study. J Clin Med 2023; 12:jcm12051843. [PMID: 36902630 PMCID: PMC10003518 DOI: 10.3390/jcm12051843] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/14/2023] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION Obesity is a common comorbidity in patients with asthma and has a significant impact on health and prognoses. However, the extent to which overweight and obesity impact asthma, particularly lung function, remains unclear. This study aimed to report on the prevalence of overweight and obesity and assess their impacts on spirometry parameters in asthmatic patients. METHODS In this multicentre, retrospective study, we reviewed the demographic data and spirometry results of all adult patients with confirmed diagnoses of asthma who visited the studied hospitals' pulmonary clinics between January 2016 and October 2022. RESULTS In total, 684 patients with confirmed diagnoses of asthma were included in the final analysis, of whom 74% were female, with a mean ± SD age of 47 ± 16 years. The prevalence of overweight and obesity among patients with asthma was 31.1% and 46.0%, respectively. There was a significant decline in spirometry results in obese patients with asthma compared with patients with healthy weights. Furthermore, body mass index (BMI) was negatively correlated with forced vital capacity (FVC) (L), forced expiratory volume in one second (FEV1), forced expiratory flow at 25-75% (FEF 25-75%) L/s and peak expiratory flow (PEF) L/s (r = -0.22, p < 0.001; r = -0.17, p < 0.001; r = -0.15, p < 0.001; r = -0.12, p < 0.01, respectively). Following adjustments for confounders, a higher BMI was independently associated with lower FVC (B -0.02 [95% CI -0.028, -0.01, p < 0.001] and lower FEV1 (B -0.01 [95% CI -0.01, -0.001, p < 0.05]. CONCLUSIONS Overweight and obesity are highly prevalent in asthma patients, and more importantly, they can reduce lung function, characterised mainly by reduced FEV1 and FVC. These observations highlight the importance of implementing a nonpharmacological approach (i.e., weight loss) as part of the treatment plan for patients with asthma to improve lung function.
Collapse
|
30
|
Romero-Falcón MA, Medina-Gallardo JF, Lopez-Campos JL, Maestre Sánchez MV, Soler Chamorro MJ, Regalado Alvertos E, Álvarez-Gutiérrez FJ. Evaluation of the Diagnostic Accuracy of Non-Specific Bronchial Provocation Tests in the Diagnosis of Asthma: A Randomized Cross-Over Study. Arch Bronconeumol 2023; 59:76-83. [PMID: 36371327 DOI: 10.1016/j.arbres.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/12/2022] [Accepted: 10/15/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The role of bronchial provocation tests in the diagnosis of asthma remains to be fully explored. We aimed to evaluate methacholine and mannitol challenge testing, and explore the factors associated with this broncoprovocation response. METHODS Observational, cross-over, randomized trial evaluating adult cases with suspected asthma, naïve to treatment, with normal pre-bronchodilator spirometry, and negative bronchodilator test. Patients were randomized to start with methacholine or mannitol. The diagnosis of bronchial asthma was confirmed if there was a good functional and clinical response to one month with twice daily formoterol/budesonide 9/320. The diagnostic profile and the concordance were calculated. Factors associated with a positive provocation test were entered into a multivariate binomial logistic regression analysis, and classification trees were created for both tests. RESULTS The study included 108 cases (50.0% diagnosed with asthma and 51.9% cases starting with methacholine). The percentage of cases positive to methacholine and mannitol were 30.6% and 25.0% respectively. Kappa values were 0.40 (p<0.001). The diagnostic profile for methacholine was sensitivity 59.3% and specificity 98.1%, while for mannitol it was sensitivity 48.1% and specificity 98.1%. Variables associated with a positive methacholine response included sex, atopy, FEV1, FEV1/FVC and FENO, whereas they were FEV1/FVC and FENO for mannitol. A FENO value>26ppb, FEV1≤103.3% and female sex correctly classified 78.7% of methacholine responders. FENO value>26ppb was enough to correctly classify 81.5% of mannitol responders. CONCLUSIONS Our study confirms the diagnostic profile of methacholine and mannitol challenge tests and describes the variable associated to their positivity with new proposed cutoff values.
Collapse
Affiliation(s)
- María Auxiliadora Romero-Falcón
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain
| | - Juan Francisco Medina-Gallardo
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain
| | - Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain; Facultad de Medicina, Universidad de Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Mª Victoria Maestre Sánchez
- Servicio de Uso Racional del Medicamento, Subdirección de Farmacia y Prestaciones, Servicio Andaluz de Salud, Spain
| | - Mª Jesús Soler Chamorro
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain
| | - Elena Regalado Alvertos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain
| | - Francisco Javier Álvarez-Gutiérrez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Spain
| |
Collapse
|
31
|
Guilleminault L, Camus C, Raherison-Semjen C, Capdepon A, Bourdin A, Bonniaud P, Fry S, Devouassoux G, Blanc FX, Pison C, Dupin C, Khayath N, Courdeau J, Valcke-Brossollet J, Nocent-Ejnaini C, Rolland F, Lamandi C, Proust A, Ozier A, Portel L, Gaspard W, Roux-Claude P, Beurnier A, Martinez S, Dot JM, Hennegrave F, Vignal G, Auvray E, Paleiron N, Just N, Miltgen J, Russier M, Olivier C, Taillé C, Didier A. Improvement in severe asthma patients receiving biologics and factors associated with persistent insufficient control: a real-life national study. Ther Adv Respir Dis 2023; 17:17534666231202749. [PMID: 37966015 PMCID: PMC10655663 DOI: 10.1177/17534666231202749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 08/22/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Biological therapies have revolutionized the treatment of severe asthma with type 2 inflammation. Although such treatments are very effective in reducing exacerbation and the dose of oral steroids, little is known about the persistence of symptoms in severe asthma patients treated with biologics. PURPOSE We aim to describe asthma control and healthcare consumption of severe asthma patients treated with biologics. DESIGN The Second Souffle study is a real-life prospective observational study endorsed by the Clinical Research Initiative in Severe Asthma: a Lever for Innovation & Science Network. METHODS Adults with a confirmed diagnosis of severe asthma for at least 12 months' duration were enrolled in the study. A self-administered questionnaire including the Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire (AQLQ) and a compliance evaluation test was given to the patients. Healthcare consumption within 12 months prior to enrolment was documented. In patients receiving biologics, doctors indicated whether the patients were biologic responders or non-responders. RESULTS The characteristics of 431 patients with severe asthma were analysed. Among them, 409 patients (94.9%) presented asthma with type 2 inflammation (T2 high) profile, and 297 (72.6%) patients with a T2 high phenotype were treated with a biologic. Physicians estimated that 88.2% of patients receiving biologics were responders. However, asthma control was only achieved in 25.3% of those patients (ACQ > 0.75). A high proportion of patients (77.8%) identified as responders to biologics were not controlled according to the ACQ score. About 50% of patients continue to use oral corticosteroids either daily (25.2%) or more than three times a year for at least three consecutive days (25.6%). Gastro-oesophageal Reflux Disease (GERD) and Obstructive Sleep Apnoea syndrome (OSA) were identified as independent factors associated with uncontrolled asthma. CONCLUSION Although a high proportion of severe asthma patients respond to biologics, only 25.3% have controlled asthma. GERD and OSA are independent factors of uncontrolled asthma.
Collapse
Affiliation(s)
- Laurent Guilleminault
- Department of Respiratory Medicine, Faculty of Medicine, Toulouse University Hospital Centre, 24 chemin de Pouvourville, Toulouse 31059, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, CNRS U5282, Toulouse, France
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
| | - Claire Camus
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
| | - Chantal Raherison-Semjen
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- University of French West Indies, Respiratory Diseases Department, Pointe -à Pitre, Guadeloupe
| | | | - Arnaud Bourdin
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- Respiratory Diseases Department, Montpellier University Hospital, Montpellier, France
| | - Philippe Bonniaud
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- Respiratory Diseases Department, Dijon University Hospital, Dijon, France
| | - Stéphanie Fry
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- Respiratory Diseases Department, Lille University Hospital, Lille, France
| | - Gilles Devouassoux
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- Respiratory Diseases Department, Lyon University Hospital, HCL, Lyon, France
| | - François-Xavier Blanc
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- Nantes Université, CHU de Nantes, INSERM, Service de Pneumologie, CIC 1413, l’Institut du Thorax, Nantes, France
| | - Christophe Pison
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- Respiratory Diseases Department, Grenoble University Hospital, Grenoble, France
| | - Clairelyne Dupin
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- Respiratory Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Naji Khayath
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- Respiratory Diseases Department, Strasbourg University Hospital, Strasbourg, France
| | - Joelle Courdeau
- Respiratory Diseases Department, Bigorre Hospital, Tarbes, France
| | | | | | - Fabien Rolland
- Respiratory Diseases Department, Cannes Hospital, Cannes, France
| | - Carmen Lamandi
- Respiratory Diseases Department, GHRMSA Hospital, Mulhouse, France
| | - Alain Proust
- Respiratory Diseases Department, Nimes Hospital, Nîmes, France
| | - Anaig Ozier
- Respiratory Diseases Department, Saint Augustin Clinic, Bordeaux, France
| | - Laurent Portel
- Respiratory Diseases Department, Libourne Hospital, Libourne, France
| | - Wanda Gaspard
- Respiratory Diseases Department, Army Training Hospital HIA Percy Clamart, Clamart, France
| | - Pauline Roux-Claude
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- Respiratory Diseases Department, Jean Minjoz University Hospital, Besançon, France
| | - Antoine Beurnier
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- Department of Physiology – Function Tests, DMU 5 Thorinno, twin-site Hôpital Bicêtre (Le Kremlin Bicêtre) and Ambroise Paré (Boulogne-Billancourt), AP-HP, Paris, France
| | - Stéphanie Martinez
- Respiratory Diseases Department, Aix-en-Provence Hospital, Aix-en-Provence, France
| | - Jean-Marc Dot
- Respiratory Diseases Department, Médipôle Hospital, Villeurbanne, France
| | | | | | - Etienne Auvray
- Respiratory Diseases Department, Métropole Savoie Hospital, Chambéry, France
| | - Nicolas Paleiron
- Respiratory Diseases Department, Army Training Hospital HIA Ste Anne Toulon, Toulon, France
| | - Nicolas Just
- Respiratory Diseases Department, Roubaix Hospital, Roubaix, France
| | - Jean Miltgen
- Respiratory Diseases Department, Polyclinique Les Fleurs, Ollioules, France
| | - Maud Russier
- Respiratory Diseases Department, Orléans Regional Hospital, Orléans, France
| | - Cécile Olivier
- Respiratory Diseases Department, La Louvière Private Hospital, Lille, France
| | - Camille Taillé
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
- Respiratory Diseases Department, Bichat Hospital, AP-HP, Paris, France
| | - Alain Didier
- Department of Respiratory Medicine, Faculty of Medicine, Toulouse University Hospital Centre, 24 chemin de Pouvourville, Toulouse 31059, France
- Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), Inserm U1291, University of Toulouse, CNRS U5282, Toulouse, France
- CRISALIS/F-CRIN INSERM Network, Toulouse, France
| |
Collapse
|
32
|
Yin C, Xie H, He X, Zhang Y, Zhang A, Li H. Small airway dysfunction in idiopathic pulmonary fibrosis. Front Pharmacol 2022; 13:1025814. [PMID: 36304160 PMCID: PMC9592693 DOI: 10.3389/fphar.2022.1025814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/29/2022] [Indexed: 11/26/2023] Open
Abstract
It is generally accepted that the pathophysiology of idiopathic pulmonary fibrosis (IPF) can be attributed to impaired lung interstitium and alveoli, while airway involvement has rarely been reported. In the present study, we aimed to investigate the actual occurrence of IPF comorbid small airway dysfunction (SAD) and its impact on survival. Data from inpatients diagnosed with IPF at Shanghai Pulmonary Hospital (Shanghai, China) from 2011 to 2021 were retrospectively collected and analyzed. Lung function parameters were used to assess SAD. A total of 243 IPF patients were included in this retrospective study, and 84 cases (84/243, 34.57%) were diagnosed with SAD. The lung histopathology showed that all 48 cases undergoing lung transplantation presented various degrees of airway lesions, of which 18 patients (18/48, 37.5%) diagnosed with SAD before lung transplantation had a higher proportion of airway distortion and obliteration. The possible risk factors associated with IPF comorbid SAD were smoking, male, younger age, and high CT fibrosis and emphysema scores. By univariate Fine-Grey regression, the hazard ratio (HR) of IPF comorbid SAD was 1.725 (95% CI 1.071, 2.777, p < 0.05). After adjusting the CTPF model and GAP model, the value of HR was 1.714 (95% CI 1.043, 2.816, p < 0.05) and 1.731 (95% CI 1.074, 2.788, p < 0.05), respectively. These findings suggested that IPF comorbid SAD was an independent risk factor for the mortality of IPF patients.
Collapse
Affiliation(s)
- Chengsheng Yin
- Department of Pulmonary and Critical Care Medicine, Yijishan Hospital, The first Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Huikang Xie
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Xian He
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| | - Aihong Zhang
- Department of Medical Statistics, Tongji University, School of Medicine, Shanghai, China
| | - Huiping Li
- Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, School of Medicine, Shanghai, China
| |
Collapse
|
33
|
Viral Infections and Wheezing in Preschool Children. Immunol Allergy Clin North Am 2022; 42:727-741. [DOI: 10.1016/j.iac.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
34
|
Park HJ, Jeon S, Lee HS, Kim BY, Chae YJ, Kim GO, Park JW, Lee JH. A Comparison of the Effectiveness of Asthma Medications on Asthma Exacerbations in Real World National Cohort. J Asthma Allergy 2022; 15:1155-1165. [PMID: 36042712 PMCID: PMC9420439 DOI: 10.2147/jaa.s379394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background Although a wide variety of asthma medications have been developed and are used in clinical practice, there is limited evidence of their comparative effects on asthma exacerbations. Methods We used claims data provided by the Health Insurance Review and Assessment Service. We selected subjects commencing asthma treatment between July 1, 2017 and June 30, 2018, with no change in drug regimen. The primary outcome was asthma exacerbation requiring systemic corticosteroids. Cox regression analysis was used to assess outcomes considering the exacerbation-free period. Results Of the 254,951 asthma subjects, 107,694 subjects (42.2%) experienced asthma exacerbation. Inhaled corticosteroids (ICSs) (hazard ratio [HR], 0.378–0.508), ICS-long-acting β2-agonist (LABAs) (HR, 0.284–0.479), long-acting muscarine antagonists (LAMAs) (HR, 0.432–0.572), leukotriene receptor antagonists (LTRAs) (HR, 0.371–0.419), and xanthines (HR, 0.326–0.482) significantly reduced the rate of first and second exacerbation of asthma (all P-values, <0.001). The clinical effectiveness of asthma medications varied according to the active ingredient (HR 0.164–0.670) and was significant for all active ingredients (all P-values, <0.001). The effectiveness of combination treatment using ICS-LABA and LTRA varied (HR, 0.159–0.670); however, all combination treatment options evaluated were effective in preventing asthma exacerbations (all P-values, <0.001). Long-term use of ICS-LABA (HR, 0.278–0.653), LTRA (HR, 0.259–0.628), and xanthines (HR, 0.351–0.783) showed consistent effectiveness (all P-values, <0.001). Conclusion This real-world study showed that the effectiveness of asthma medications varied according to drug type, active ingredient, combination, and period of use, although effectiveness was significant in all cases studied.
Collapse
Affiliation(s)
- Hye Jung Park
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Bo Yeon Kim
- Healthcare Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Yu Jin Chae
- Healthcare Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Gui Ok Kim
- Healthcare Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Jung-Won Park
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyun Lee
- Division of Allergy and Immunology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Allergy, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
35
|
Asthma, bronchiectasis, and chronic obstructive pulmonary disease: the Bermuda Triangle of the airways. Chin Med J (Engl) 2022; 135:1390-1393. [PMID: 35869863 PMCID: PMC9481445 DOI: 10.1097/cm9.0000000000002225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|