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Liu L, Shang Y, Li M, Han X, Wang J, Wang J. Curcumin ameliorates asthmatic airway inflammation by activating nuclear factor-E2-related factor 2/haem oxygenase (HO)-1 signalling pathway. Clin Exp Pharmacol Physiol 2016; 42:520-9. [PMID: 25739561 DOI: 10.1111/1440-1681.12384] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Revised: 02/26/2015] [Accepted: 02/26/2015] [Indexed: 12/27/2022]
Abstract
Previous studies have shown that curcumin alleviates asthma in vivo. However, the relationship between curcumin and the nuclear factor-E2-related factor 2 (Nrf2)/haem oxygenase (HO)-1 pathway in asthma treatment remains unknown. The aim of the present study was to investigate the mechanisms of curcumin involved in the amelioration of airway inflammation in a mouse asthma model. Curcumin was administrated to asthmatic mice, and bronchoalveolar lavage fluid was collected. Inflammatory cell infiltration was measured by Giemsa staining. Immunoglobulin E production in bronchoalveolar lavage fluid was measured by enzyme-linked immunosorbent assay. Histological analyses were evaluated with haematoxylin-eosin and periodic acid-Schiff staining. Airway hyperresponsiveness was examined by whole-body plethysmography. Nuclear factor-E2-related factor 2, HO-1, nuclear factor-κB and inhibitory κB/p-inhibitory κB levels in lung tissues were detected by western blot, and Nrf2 activity was measured by electrophoretic mobility shift assay. Tumour necrosis factor-α, interleukin (IL)-1β, and IL-6 levels in the small interfering RNA-transfected cells were detected by enzyme-linked immunosorbent assay. Curcumin treatment significantly reduced immunoglobulin E production, attenuated inflammatory cell accumulation and goblet cell hyperplasia, and ameliorated mucus secretion and airway hyperresponsiveness. Nuclear factor-E2-related factor 2 and HO-1 levels in lung tissues were significantly increased. Meanwhile, Nrf2 activity was enhanced. Nuclear factor-κB and p-inhibitory κB levels were elevated in the lung tissue of ovalbumin-challenged mice. Both were restored to normal levels after curcumin treatment. Haem oxygenase-1 and nuclear Nrf2 levels were enhanced in dose- and time-dependent manners in curcumin-treated RAW264.7 cells. Curcumin blocked lipopolysaccharide-upregulated expression of tumour necrosis factor-α, IL-1β, and IL-6. After the cells were transfected with HO-1 or Nrf2 small interfering RNA, lipopolysaccharide-induced pro-inflammation cytokine expression was significantly restored. In summary, curcumin might alleviate airway inflammation in asthma through the Nrf2/HO-1 pathway, potentially making it an effective drug in asthma treatment.
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Affiliation(s)
- Liyun Liu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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Lau MYZ, Dharmage SC, Burgess JA, Lowe AJ, Lodge CJ, Campbell B, Matheson MC. CD14 polymorphisms, microbial exposure and allergic diseases: a systematic review of gene-environment interactions. Allergy 2014; 69:1440-53. [PMID: 24889096 DOI: 10.1111/all.12454] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2014] [Indexed: 11/30/2022]
Abstract
Asthma and allergy may develop as a result of interactions between environmental factors and the genetic characteristics of an individual. This review aims to summarize the available evidence for, and potential effects of, an interaction between polymorphisms of the CD14 gene and exposure to microbes on the risk of asthma and allergic diseases. We searched PubMed, MEDLINE and Global Health databases, finding 12 articles which met inclusion criteria. Most studies reported a significant interaction between CD14 polymorphisms and microbial exposure. When stratified by age at microbial exposure (early life vs adult life), there was evidence of a protective effect of gene-environment interaction against atopy in children, but not adults. We also found different effects of interaction depending on the type of microbial exposures. There was no strong evidence for asthma and eczema. Future studies should consider a three-way interaction between CD14 gene polymorphisms, microbial exposures and the age of exposure.
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Affiliation(s)
- M. Y. Z. Lau
- Centre for Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - S. C. Dharmage
- Centre for Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - J. A. Burgess
- Centre for Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - A. J. Lowe
- Centre for Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - C. J. Lodge
- Centre for Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - B. Campbell
- Centre for Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
| | - M. C. Matheson
- Centre for Epidemiology and Biostatistics; School of Population and Global Health; The University of Melbourne; Carlton Vic. Australia
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Fasmer OB, Halmøy A, Eagan TM, Oedegaard KJ, Haavik J. Adult attention deficit hyperactivity disorder is associated with asthma. BMC Psychiatry 2011; 11:128. [PMID: 21819624 PMCID: PMC3163523 DOI: 10.1186/1471-244x-11-128] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 08/07/2011] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is increasingly recognized as a common disorder not only in children, but also in the adult population. Similarly, asthma also has a substantial prevalence among adults. Previous studies concerning a potential relationship between ADHD and asthma have not presented consistent results. METHODS A cross-sectional study of 594 adult patients diagnosed with ADHD, compared with 719 persons from the general population. Information was collected between 1997 and 2005 using auto-questionnaires rating past and present symptoms of ADHD, co-morbid conditions, including asthma, and work status. RESULTS The prevalence of asthma was significantly higher in the ADHD patient group compared to the controls, 24.4% vs. 11.3% respectively (OR = 2.54, 95% CI 1.89-3.44), and controls with asthma scored higher on ratings of both past and present symptoms of ADHD. Female ADHD patients had a significantly higher prevalence of asthma compared to male ADHD patients (30.9% vs. 18.2%, OR = 2.01, CI 1.36-2.95), but in controls a slight female preponderance was not statistically significant. In both ADHD patients and controls, having asthma was associated with an increased prevalence of symptoms of mood- and anxiety disorders. CONCLUSIONS The present findings point to a co-morbidity of ADHD and asthma, and these patients may represent a clinical and biological subgroup of adult patients with ADHD.
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Affiliation(s)
- Ole Bernt Fasmer
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway.
| | - Anne Halmøy
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway,Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Tomas Mikal Eagan
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway,Institute of Medicine, Section for Thoracic Medicine, University of Bergen, Bergen, Norway
| | - Ketil Joachim Oedegaard
- Department of Clinical Medicine, Section for Psychiatry, University of Bergen, Bergen, Norway,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Jan Haavik
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway,Department of Biomedicine, University of Bergen, Bergen, Norway
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Apter AJ. Advances in adult asthma diagnosis and treatment in 2009. J Allergy Clin Immunol 2010; 125:79-84. [PMID: 20109739 DOI: 10.1016/j.jaci.2009.11.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Accepted: 11/19/2009] [Indexed: 12/28/2022]
Abstract
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.
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Affiliation(s)
- Andrea J Apter
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Apter AJ. Advances in adult asthma diagnosis and treatment and health outcomes, education, delivery, and quality in 2008. J Allergy Clin Immunol 2009; 123:35-40. [PMID: 19130925 DOI: 10.1016/j.jaci.2008.11.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 11/19/2008] [Indexed: 01/05/2023]
Abstract
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.
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Affiliation(s)
- Andrea J Apter
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Lee KY, Park SJ, Kim SR, Min KH, Choe YH, Jin GY, Lee YC. Low attenuation area is associated with airflow limitation and airway hyperresponsiveness. J Asthma 2008; 45:774-9. [PMID: 18972294 DOI: 10.1080/02770900802252135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Asthma is a chronic inflammatory disorder of the airways characterized by airflow limitation and airway hyperresponsiveness. Lung density indices on quantitative computed tomography (QCT) are assumed to reflect the degree of air trapping originated from airflow limitation in airway diseases. PURPOSE The present study investigated the availability of lung density indices on QCT in clinical evaluation of asthma. METHODS Eleven asthmatic patients and 48 healthy control subjects were prospectively evaluated by QCT, pulmonary function testing, and a methacholine challenge test. High-resolution computed tomography scans were performed at full-inspiratory and full-expiratory phases, and percentage of lung field occupied by low attenuation area (LAA%) and mean lung density (MLD) at both inspiratory and expiratory phases were measured. RESULTS MLD values at inspiratory phase were significantly increased in asthmatic patients compared with those in healthy control subjects. Inspiratory LAA% values were significantly decreased in asthmatics compared with the values in control subjects. On expiratory scans, MLD values of asthmatics were significantly lower than the values of control subjects. Expiratory LAA% values of asthmatics were significantly higher than the values of control subjects. The LAA% in the expiratory phase showed significant negative correlation with forced expiratory volume in 1 second (FEV(1)), FEV(1)/forced vital capacity, and the provocative dose of methacholine causing a 20% decrease in FEV(1) in asthmatic patients. CONCLUSION These results suggest that lung density indices on QCT may be useful for clinical evaluation of asthmatic patients and increased LAA% in the expiratory phase is associated with airflow limitation and airway hyperresponsiveness in asthma.
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Affiliation(s)
- Ka Young Lee
- Department of Internal Medicine and Airway Remodeling Laboratory, Chonbuk National University Medical School, Deokjin-Gu, Jeonju, South Korea
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Apter AJ. Advances in the care of adults with asthma and allergy in 2007. J Allergy Clin Immunol 2008; 121:839-44. [PMID: 18261788 DOI: 10.1016/j.jaci.2007.12.1176] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2007] [Revised: 12/27/2007] [Accepted: 12/27/2007] [Indexed: 01/10/2023]
Abstract
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.
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Affiliation(s)
- Andrea J Apter
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Szefler SJ. Advances in pediatric asthma in 2007. J Allergy Clin Immunol 2008; 121:614-9. [PMID: 18234318 DOI: 10.1016/j.jaci.2007.11.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Accepted: 11/30/2007] [Indexed: 11/16/2022]
Abstract
This year's summary focuses on recent advances in pediatric asthma as reported in 2007 publications in the Journal. This past year, new National Asthma Education and Prevention Program asthma guidelines were released with a special emphasis on new information in pediatric asthma. Journal theme issues in 2007 included the revised National Asthma Education and Prevention Program asthma guidelines, the accomplishments of the National Institutes of Health asthma networks, and focused discussions on environmental allergens, neutrophils, eosinophils, T cells, and epithelial cells, all of which affect pediatric asthma. The new asthma guidelines emphasize several key terms including severity, control, impairment, risk, and responsiveness that are relevant for advancing the care of children with asthma. This review highlights journal articles that relate to these guideline topics.
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Affiliation(s)
- Stanley J Szefler
- Division of Pediatric Clinical Pharmacology, Department of Pediatrics, National Jewish Medical and Research Center, Denver, CO 80206, USA.
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Peters SP, Jones CA, Haselkorn T, Mink DR, Valacer DJ, Weiss ST. Real-world Evaluation of Asthma Control and Treatment (REACT): Findings from a national Web-based survey. J Allergy Clin Immunol 2007; 119:1454-61. [PMID: 17481716 DOI: 10.1016/j.jaci.2007.03.022] [Citation(s) in RCA: 179] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 03/20/2007] [Accepted: 03/22/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Despite health initiatives for advancing the management of asthma, evidence suggests that many asthmatic subjects have uncontrolled disease. However, the prevalence of uncontrolled asthma in the United States is not known and has not been fully characterized. OBJECTIVE We sought to assess the prevalence, morbidity, and factors associated with uncontrolled asthma in a nationally representative sample of patients with moderate-to-severe asthma using standard asthma medications. METHODS A Web-based survey was administered to patients with diagnoses of asthma for at least 1 year who were receiving multiple controller medications. The Asthma Control Test score was used to stratify respondents into controlled and uncontrolled cohorts. RESULTS A total of 1812 patients were assessed; 809 (45%) had controlled asthma, and 1003 (55%) had uncontrolled asthma. Most patients had health care coverage and received care from a general practitioner; a large proportion of patients with controlled asthma (74%) and patients with uncontrolled asthma (65%) reported never receiving an asthma action plan. Inhaled corticosteroid plus long-acting beta-agonist was the most common medication regimen in patients with controlled asthma (60%) and patients with uncontrolled asthma (48%) patients. Patients with uncontrolled asthma reported significantly higher rates of health care use. Several comorbidities were predictive of uncontrolled asthma. CONCLUSION Uncontrolled asthma is highly prevalent (55%) in patients using standard asthma medications. There is need for improved asthma care in patients with moderate-to-severe asthma, including a global evaluation of asthma control, implementation of treatment plans and asthma control tests, and addressing comorbid conditions. CLINICAL IMPLICATIONS Improved asthma care requires broader assessments of asthma control, including asthma-related health care and medication use, comorbidities, and the implementation of treatment plans and formal asthma control tests.
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Affiliation(s)
- Stephen P Peters
- Center for Human Genomics and Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
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Chipps BE, Szefler SJ, Simons FER, Haselkorn T, Mink DR, Deniz Y, Lee JH. Demographic and clinical characteristics of children and adolescents with severe or difficult-to-treat asthma. J Allergy Clin Immunol 2007; 119:1156-63. [PMID: 17397912 DOI: 10.1016/j.jaci.2006.12.668] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 11/22/2006] [Accepted: 12/01/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young patients with severe or difficult-to-treat asthma are an understudied population. OBJECTIVE To assess age-associated and gender-associated differences in children and adolescents in the observational study, The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens. METHODS Cross-sectional baseline data for patients greater than or equal to 6 years and less than or equal to 17 years (n = 1261) were stratified by age group (6-8, 9-11, 12-14, and 15-17 years). The chi(2) test for categorical variables and analysis of variance for continuous variables were used to identify differences among age groups, stratified by gender. RESULTS Most patients had moderate (55%) or severe (41%) asthma by physician assessment. Of those using greater than or equal to 3 long-term controllers (62%), 53% of children (6-11 years) and 44% of adolescents (12-17 years) reported an oral corticosteroid burst and 25% and 19%, respectively, had an emergency department visit in the previous 3 months; 10% and 15%, respectively, reported past intubation. In females, weight for age ranged between the 67th and 70th percentiles; height for age was between the 42nd and 54th percentiles (P < .01 among age groups). Lung function was lower in adolescents than children: prebronchodilator percent predicted forced expiratory volume in 1 second (FEV(1))/forced vital capacity was 0.92 (6-8 years) and 0.83 (15-17 years), P less than .05, in males; and 0.94 (6-8 years) and 0.87 (15-17 years), P less than .05, in females. CONCLUSIONS Children and adolescents demonstrated high rates of health care use and loss of lung function, despite using multiple long-term controllers. CLINICAL IMPLICATIONS Asthma treatments that prevent loss of lung function and reduce health care resource use are needed in young patients with severe or difficult-to-treat asthma.
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Affiliation(s)
- Bradley E Chipps
- Capital Allergy and Respiratory Disease Center, Sacramento, CA 95819, USA.
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de Blic J, Scheinmann P. The use of imaging techniques for assessing severe childhood asthma. J Allergy Clin Immunol 2007; 119:808-10. [PMID: 17289134 DOI: 10.1016/j.jaci.2006.12.657] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Revised: 12/12/2006] [Accepted: 12/13/2006] [Indexed: 01/15/2023]
Abstract
Computed tomography (CT) scans are usually performed in children with asthma to exclude alternative diagnoses. Technical improvements of high-resolution CT (HRCT) scans have increased the spatial resolution sufficiently for the theoretical quantification of bronchial wall thickening of the proximal airways and the assessment of small airway disease by the extent and degree of low attenuation areas, which are believed to represent air trapping. In contrast with adults, very few studies have been performed in children. The results suggest that the HRCT scan might be useful as a noninvasive technique for airway inflammation and airway remodeling. In the future, the potential use of HRCT scans for determining optimal treatment should be evaluated. However, several issues remain to be resolved, including the validity of algorithm reconstruction, the imaging parameters to be used, and the application of this technique to young children. Furthermore, because of its cost and the irradiation involved, this examination is highly unlikely to be used routinely for the management and follow-up of all children with asthma but will likely be restricted to patients with severe asthma.
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Affiliation(s)
- Jacques de Blic
- Université Paris Descartes, Assistance Publique des Hôpitaux de Paris, Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Paris, France.
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Apter AJ. Advances in adult asthma 2006: its risk factors, course, and management. J Allergy Clin Immunol 2007; 119:563-6. [PMID: 17270262 DOI: 10.1016/j.jaci.2007.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2006] [Revised: 12/28/2006] [Accepted: 01/02/2007] [Indexed: 01/03/2023]
Abstract
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.
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Affiliation(s)
- Andrea J Apter
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USa.
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Szefler SJ. Advances in pediatric asthma 2006. J Allergy Clin Immunol 2007; 119:558-62. [PMID: 17270259 DOI: 10.1016/j.jaci.2006.12.619] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 12/08/2006] [Accepted: 12/13/2006] [Indexed: 01/02/2023]
Abstract
Because the outcomes experienced in adult asthma often result from pathophysiology that begins in early childhood, this year's summary focuses on recent advances in pediatric asthma. This past year, we have learned that early intervention with inhaled corticosteroids in childhood asthma reduces morbidity but does not alter the natural history of asthma. Theme issues over the last year focused attention on severe asthma and black box warnings. Both of these themes significantly affect the management of childhood asthma. Responsiveness to asthma treatment is heterogeneous even among patients with asthma of similar severity. This heterogeneity calls attention to the importance of assessing control and adjusting treatment accordingly. We are now moving toward an individualized approach to asthma therapy and searching for biomarkers and genetics as a resource to guide treatment. To improve asthma control, we must continue to obtain information on early asthma, severe asthma, asthma exacerbations, and methods to improve asthma control. Evaluation and management of severe asthma in children include verification of the diagnosis, assessment for coexisting illnesses, and identification of effective treatment strategies directed to adherence, medication delivery, and combination therapy. Application of biomarkers and genetics could be useful tools in individualizing our approach to the management of childhood asthma.
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Affiliation(s)
- Stanley J Szefler
- Divisions of Pediatric Clinical Pharmacology, Allergy and Immunology, Department of Pediatrics, National Jewish Medical and Research Center, Denver, CO 80206, USA.
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Les présentations cliniques. OSTÉOPATHIE PÉDIATRIQUE 2007. [PMCID: PMC7271215 DOI: 10.1016/b978-2-84299-917-9.50007-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gergen PJ, Apter AJ. Unconventional risk factors: another pathway to understanding health disparities. J Allergy Clin Immunol 2006; 119:165-7. [PMID: 17141856 DOI: 10.1016/j.jaci.2006.10.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 10/31/2006] [Accepted: 10/31/2006] [Indexed: 01/19/2023]
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