Advances in adult and pediatric asthma

Polymorphisms of the IL-18 promoter and bronchial asthma

To study the association of polymorphisms of the IL-18 promoter (-607C/A and -137G/C) with bronchial asthma, 120 subjects with bronchial asthma were selected as the experimental group (49 cases with bronchial asthma and allergic rhinitis as experimental group 1 and 71 cases with bronchial asthma without allergic rhinitis as experimental group 2) and 120 healthy individuals were selected as the control group. A polymerase chain reaction sequence-specific primer (PCR-SSP) was used to identify the genotypic polymorphisms between the experimental and control groups. The results revealed that the frequencies of the CC, CA and AA genotypes at -607C/A in experimental group 1 were 18.37, 40.82 and 40.82%, respectively; these frequencies were 32.39, 54.92 and 12.68%, respectively, in experimental group 2. There was a statistically significant difference in the genotype distribution between experimental groups 1 and 2 (χ²=12.81; P<0.05). The allele frequencies of genotypes C and A were 38.78 and 61.22%, respectively, in experimental group 1 and 59.86 and 40.14%, respectively, in experimental group 2. The allele frequencies at -607C/A were significantly different between experimental groups 1 and 2 (χ²=10.32; P<0.05). Frequencies of genotypes GG, GC and CC at -137C/A in experimental group 1 were 48.98, 46.94 and 4.08%, respectively, and 80.28, 14.08 and 4.08% in experimental group 2 with significant difference (χ²=15.73, P<0.05). Allele frequencies of G and C in experimental group 1 were 72.45 and 27.55%, and 87.32 and 12.68% in experimental group 2 with statistically significant difference (χ²=8.42, P<0.05). In conclusion, polymorphisms of the IL-18 gene promoter at -607C/A and -137G/C were associated with allergic rhinitis in bronchial asthma, indicating that polymorphisms of the IL-18 gene promoter at -607C/A and -137G/C differentially affect the pathogenesis of asthma and allergic rhinitis.

Severe Asthma

Despite vast improvements in the care of children with asthma over the past decades, asthma remains a common cause of admission to pediatric intensive care units. During the 1990s asthma prevalence and hospital admissions increased in the United States and worldwide. The increase occurred in both males and females and across all ethnic groups. However, the largest increases occurred in children of low socioeconomic status living in urban settings. Recent asthma statistics should be interpreted with consideration of changes made in the method for reporting asthma prevalence (Fig. 23-1). From 1980 to 1996, the National Health Interview Survey (NHIS) conducted by the CDC measured pediatric asthma prevalence as the percentage of children with asthma in the past 12 months. Since 1997, asthma prevalence estimates have been defined as: having received an asthma diagnosis, currently having the disease at the time of the interview, and experiencing an attack in the past year. The more specific definition may have led to a reduction in the number of children reported to have asthma.

Advances in adult asthma diagnosis and treatment in 2009

There is a growing need to standardize and validate outcomes for asthma research. In this review of asthma-related publications from the Journal in 2009, efforts to standardize methodology and reporting of translational research, the influence of the environment, therapeutics, and management of asthma are highlighted.

Advances in adult asthma diagnosis and treatment and health outcomes, education, delivery, and quality in 2008

In 2008 the Journal reported new findings in management of asthma. Dosing schedules of inhaled steroids have been modified and individualized. New, more costly propellants are replacing ozone-depleting chlorofluorocarbons. An association of asthma with pneumococcal disease has been observed. Smoking bans in public places are eliminating second-hand smoke and reducing asthma-related emergency department visits among adults. In contrast with these advances, however, disparity in asthma morbidity persists: black persons compared with white persons have a 4-fold greater risk of an asthma-related emergency department visit.

Advances in therapy for adult asthma

There are >22 million Americans with asthma. Chronic asthma is a worldwide problem with an increasing socioeconomic burden on individuals and on society. Recent advances have been made in diagnostic lung imaging, defining control of asthma, as well as in the education of patients with asthma. Accurate diagnosis of the cause of chronic cough in adults and of asthma in elderly individuals will help affected individuals receive appropriate treatment. Inhaled corticosteroids are the recommended first-line therapy for persistent asthma and can help prevent exacerbations in patients with asthma that are not well controlled. Early intervention and improved management can significantly reduce the socioeconomic burden of asthma. Patient education is an essential part of asthma management.

Advances in the care of adults with asthma and allergy in 2007

In 2007 the National Asthma Education and Prevention Program published the Expert Panel Report 3, updating its 1997 and 2002 guidelines for the diagnosis and management of asthma with new emphasis on assessment and attainment of control. This review focuses on the Journal articles published in 2007 pertaining to risk and impairment in adult asthma and interventions to improve its control.

Advances in adult asthma 2006: its risk factors, course, and management

This Advances article updates our understanding of risk factors for asthma and its course and management. Studies relevant to clinical practice are discussed, with special attention to their clinical research methods.

Advances in adult and pediatric asthma

This year we present updates on the management and therapeutics of asthma and research on the relationship of airway remodeling to clinically irreversible disease and continue a discussion about the origins of asthma. Significant advances are occurring in our understanding of the natural history of asthma, including the application of biomarkers and genetics. These tools should assist the clinician in defining patients at risk for significant morbidity related to asthma. Incorporating this knowledge will help prompt the development of more effective management techniques and new medications. Meanwhile, more effective health care strategies must be developed to reduce the reported disparities in asthma care noted in our patient populations.

Local anaesthetic medication for the treatment of asthma

It is presumed that drugs able to prevent bronchial spasm and/or inflammation may have therapeutic potential to control asthma symptoms. The local anaesthetic lidocaine has recently received increased attention as an alternative form of treatment for asthmatic patients. This paper reviews the major findings on the topic and summarizes the putative mechanisms underlying the airway effects of local anaesthetic agents. We think that lidocaine extends the spectrum of options in asthma therapy, probably by counteracting both spasmogenic and inflammatory stimuli in the bronchial airways. The possibility of development of new anti-asthma compounds based on the synthesis of lidocaine derivatives is also on the horizon.

Variability analysis of oscillatory airway resistance in children

Testing pulmonary function in preschool children is problematic since individual cooperation is often insufficient to yield adequate results. This is especially the case when repetitive measurements are carried out, e.g., during provocation tests in order to diagnose bronchial hyperresponsiveness. We therefore sought to determine whether the variability of the oscillatory airway resistance, which can be measured with minimal patient cooperation, might serve as an approach to separate asymptomatic children with asthma from age-matched healthy controls. Monofrequent forced oscillation technique was used to measure the oscillatory resistance (Ros) continuously at a repetition rate of 10 Hz. Forty consecutive values of Ros at the end of expiration (Ros(pe)) and at the end of inspiration (Ros(pi)) were used to calculate variability measures [standard deviation (SD), averaged deviation (LD), root mean square successive differences (RMSSD)] known from heart rate variability analysis to describe the airway diameter variability in 36 asthmatics and 21 healthy controls. Airway diameter variability of Ros(pi) and Ros(pe) as expressed by SD from the mean (P = 0.01 and 0.05, respectively), from LD (P = 0.01 and 0.21, respectively) and from the RMSSD (P = 0.006 and 0.03, respectively) was greater in patients with asthma. Mean values of Ros(pi) and Ros(pe) were not different between groups. Airway diameter variability is higher in asymptomatic children with asthma than in healthy controls. Future research should evaluate whether the measurement of the variability of Ros(pi), which does not require the patient's cooperation, can give similar information as challenge tests with respect to bronchial hyperresponsiveness.

Exhaled nitric oxide in the clinical management of asthma

Management of asthma has gradually evolved from the concept of controlling bronchial hyperresponsiveness to focusing on control of inflammation. The awareness of airway remodeling, and the emergence of data suggesting irreversibility of some of these changes, despite standard-of-care pharmacotherapies such as inhaled steroids, has highlighted the need for early detection; effective diagnosis and treatment; monitoring responses and adhering to treatment; and predicting exacerbations. Pre-clinical intervention strategies targeted toward picking up early suggestions of asthma before irreversible airway changes occur may open the door to primary prevention approaches. Although invasive methods, such as bronchial biopsy, remain the gold standard to understanding and treating asthma, there is a preference for noninvasive techniques for reasons of convenience, ease of use, and patient comfort. In this article, recent data that support the use of exhaled nitric oxide as a noninvasive biomarker of inflammation in clinical practice are reviewed.