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Abu Al Karsaneh O, Al Anber A, Al Shboul S, Alrjoub M, Almashaqbeh OI, Alqaisi M, Abuatieh R, Ananzeh SM, Hamad AM, Almomani R, Tommalieh MM. Impact of Anxiety and Depression on the Level of Asthma Control Among Jordanian Adults with Asthma. J Asthma Allergy 2024; 17:463-476. [PMID: 38784527 PMCID: PMC11114137 DOI: 10.2147/jaa.s457875] [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: 01/03/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
Purpose Recent studies imply that psychological factors may actively contribute to the development of asthma. It is generally known that people with asthma frequently suffer from psychological illnesses. This association can make it challenging to reach asthma control. This study aimed to assess the prevalence of depression and anxiety among Jordanian adults with asthma, in addition to the link between asthma control levels and these psychological disorders. Patients and Methods This cross-sectional study included 175 adults with asthma who visited the tertiary asthma clinic in three Jordanian Governmental hospitals. Sociodemographic data was collected directly from the patients who were assessed for their level of depression and anxiety using a self-administered questionnaire, the Hospital Anxiety and Depression Scale (HADS). Also, asthma control was assessed using the Asthma Control Test (ACT). The relation between the different sociodemographic variables and clinical data, particularly depression and anxiety and asthma control level, was assessed. Results Among 175 asthmatic patients, 60.57% had poor disease control, 8% had anxiety alone, 11.43% had depression alone, and 53.14% had anxiety plus depression. Poor asthma control was significantly associated with anxiety and depression (p= 0.044) and low levels of education (p=0.001). Further, a lower level of education was also related to higher levels of anxiety and depression. Conclusion Most of the assessed Jordanian patients with asthma had their disease poorly controlled. Anxiety and depression are common among the studied sample of adults with asthma, and they appear to affect the level of disease control, suggesting the possibility that addressing these psychological conditions could enhance asthma control levels.
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Affiliation(s)
- Ola Abu Al Karsaneh
- Department of Microbiology, Pathology and Forensic Medicine, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan
| | - Arwa Al Anber
- Department of Pharmacology and Public Health, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan
| | - Sofian Al Shboul
- Department of Pharmacology and Public Health, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan
| | - Moath Alrjoub
- Department of Pathology and Microbiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | | | - Mohammad Alqaisi
- Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan
| | - Rahaf Abuatieh
- Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan
| | | | - Anas Mousa Hamad
- Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan
| | - Raneem Almomani
- Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan
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Redel A, Feleszko W, Arcolaci A, Cefaloni F, Atanaskovic‐Markovic M, Braunstahl G, Boccabella C, Bonini M, Karavelia A, Louwers E, Mülleneisen N, O'Mahony L, Pini L, Rapiejko A, Shehu E, Sokolowska M, Untersmayr E, Tramper‐Stranders G. A survey study on antibiotic prescription practices for acute asthma exacerbations: An European academy of allergy and clinical immunology task force report. Clin Transl Allergy 2024; 14:e12345. [PMID: 38497844 PMCID: PMC10946284 DOI: 10.1002/clt2.12345] [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: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
INTRODUCTION Guidelines recommend treating asthma exacerbations (AAEs) with bronchodilators combined with inhaled and/or systemic corticosteroids. Indications for antibiotic prescriptions for AAEs are usually not incorporated although the literature shows antibiotics are frequently prescribed. AIM To investigate the antibiotic prescription rates in AAEs and explore the possible determining factors of those practices. METHODS A digital survey was created to determine the antibiotic prescription rates in AAEs and the influencing factors for the prescription practices. The survey was distributed among European academy of allergy and clinical immunology (EAACI) members by mass emailing and through regional/national societies in the Netherlands, Italy, Greece, and Poland. Furthermore, we retrieved local antibiotic prescription rates. RESULTS In total, 252 participants completed the survey. Respondents stated that there is a lack of guidelines to prescribe antibiotics in AAEs. The median antibiotic prescription rate in this study was 19% [IQR: 0%-40%] and was significantly different between 4 professions: paediatrics 0% [IQR: 0%-37%], pulmonologists 25% [IQR: 10%-50%], general practitioners 25% [IQR: 0%-50%], and allergologists 17% [IQR: 0%-33%]) (p = 0.046). Additional diagnostic tests were performed in 71.4% of patients before prescription and the most common antibiotic classes prescribed were macrolides (46.0%) and penicillin (42.9%). Important clinical factors for health care providers to prescribe antibiotics were colorised/purulent sputum, abnormal lung sounds during auscultation, fever, and presence of comorbidities. CONCLUSION In 19% of patients with AAEs, antibiotics were prescribed in various classes with a broad range among different subspecialities. This study stresses the urgency to compose evidence-based guidelines to aim for more rational antibiotic prescriptions for AAE.
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Affiliation(s)
- Anne‐Lotte Redel
- Department of PulmonologyFranciscus Gasthuis & VlietlandRotterdamThe Netherlands
- Department of PulmonologyErasmus Medical CenterRotterdamThe Netherlands
| | - Wojciech Feleszko
- Department of Pediatric Allergy and PneumonologyMedical University of WarsawWarsawPoland
| | - Alessandra Arcolaci
- Immunology UnitUniversity of Verona and General Hospital Borgo Roma HospitalVeronaItaly
| | | | | | - Gert‐Jan Braunstahl
- Department of PulmonologyFranciscus Gasthuis & VlietlandRotterdamThe Netherlands
- Department of PulmonologyErasmus Medical CenterRotterdamThe Netherlands
| | - Cristina Boccabella
- Faculty of Medicine and SurgeryRespiratory MedicineCatholic University of the Sacred HeartMilanItaly
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic SciencesUniversità Cattolica del Sacro CuoreFondazione Policlinico Universitario A. Gemelli ‐ IRCCSRomeItaly
- National Heart and Lung InstituteRoyal Brompton Hospital & Imperial College LondonLondonUK
| | - Aspasia Karavelia
- Department of Ear‐Nose‐Throat SurgeryGeneral Hospital of NafplioNafplioGreece
| | - Eefje Louwers
- General PracticeGezondheidscentrum Berkel en RodenrijsBerkel en RodenrijsThe Netherlands
| | | | - Liam O'Mahony
- Department of MedicineSchool of MicrobiologyAPC Microbiome IrelandNational University of IrelandCorkIreland
| | - Laura Pini
- Department of Clinical and Experimental SciencesRespiratory Medicine UnitUniversity of BresciaASST Spedali Civili di BresciaBresciaItaly
| | - Anna Rapiejko
- Department of Pediatric Allergy and PneumonologyMedical University of WarsawWarsawPoland
| | - Esmeralda Shehu
- Internal Medicine DepartmentDurres Regional HospitalDurresAlbania
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research (SIAF)University of ZurichZürichSwitzerland
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy ResearchCenter of PathophysiologyInfectiology and ImmunologyMedical University of ViennaViennaAustria
| | - Gerdien Tramper‐Stranders
- Department of PulmonologyErasmus Medical CenterRotterdamThe Netherlands
- Department of PediatricsFranciscus Gasthuis & VlietlandRotterdamThe Netherlands
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Ahn S, Maarsingh H, Walker JK, Liu S, Hegde A, Sumajit HC, Kahsai AW, Lefkowitz RJ. Allosteric modulator potentiates β2AR agonist-promoted bronchoprotection in asthma models. J Clin Invest 2023; 133:e167337. [PMID: 37432742 PMCID: PMC10503797 DOI: 10.1172/jci167337] [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: 11/21/2022] [Accepted: 07/06/2023] [Indexed: 07/12/2023] Open
Abstract
Asthma is a chronic inflammatory disease associated with episodic airway narrowing. Inhaled β2-adrenergic receptor (β2AR) agonists (β2-agonists) promote - with limited efficacy - bronchodilation in asthma. All β2-agonists are canonical orthosteric ligands that bind the same site as endogenous epinephrine. We recently isolated a β2AR-selective positive allosteric modulator (PAM), compound-6 (Cmpd-6), which binds outside of the orthosteric site and modulates orthosteric ligand functions. With the emerging therapeutic potential of G-protein coupled receptor allosteric ligands, we investigated the impact of Cmpd-6 on β2AR-mediated bronchoprotection. Consistent with our findings using human β2ARs, Cmpd-6 allosterically potentiated β2-agonist binding to guinea pig β2ARs and downstream signaling of β2ARs. In contrast, Cmpd-6 had no such effect on murine β2ARs, which lack a crucial amino acid in the Cmpd-6 allosteric binding site. Importantly, Cmpd-6 enhanced β2 agonist-mediated bronchoprotection against methacholine-induced bronchoconstriction in guinea pig lung slices, but - in line with the binding studies - not in mice. Moreover, Cmpd-6 robustly potentiated β2 agonist-mediated bronchoprotection against allergen-induced airway constriction in lung slices obtained from a guinea pig model of allergic asthma. Cmpd-6 similarly enhanced β2 agonist-mediated bronchoprotection against methacholine-induced bronchoconstriction in human lung slices. Our results highlight the potential of β2AR-selective PAMs in the treatment of airway narrowing in asthma and other obstructive respiratory diseases.
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Affiliation(s)
- Seungkirl Ahn
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Harm Maarsingh
- Department of Pharmaceutical Sciences, Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, Florida, USA
| | - Julia K.L. Walker
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Samuel Liu
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Akhil Hegde
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Hyeje C. Sumajit
- Department of Pharmaceutical Sciences, Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, Florida, USA
| | - Alem W. Kahsai
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robert J. Lefkowitz
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biochemistry and
- Howard Hughes Medical Institute, Duke University School of Medicine, Durham, North Carolina, USA
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Giordano F, Guidotti S, Giordano T, Pruneti C. Clinical and psychological aspects in a group of allergic asthma patients and the impact on their health status perception. HEALTH PSYCHOLOGY REPORT 2023; 11:321-330. [PMID: 38178964 PMCID: PMC10762305 DOI: 10.5114/hpr/168790] [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: 10/07/2022] [Revised: 02/24/2023] [Accepted: 06/26/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND The interplay between physical and psychological symptoms frequently affects the health-related quality of life of asthma patients. PARTICIPANTS AND PROCEDURE This research aimed at assessing the psychological status of 60 patients attending their first/second doctor visit at which they were diagnosed with allergic asthma. Information on psychological distress was collected through the Symptom Questionnaire (SQ), personality traits were described through Cattell's 16-Personality Factor Questionnaire (16-PF), stress-related behavior was detected through the P Stress Questionnaire (PSQ), and the perceived quality of life was described with the Rhinasthma questionnaire. RESULTS The SQ revealed anxiety levels above the clinical cut-off in 71.7% of patients, levels of depression in 46.7%, anger-hostility in 53.3%, and somatic symptoms in 65%. No significant differences were observed after three months. The 16-PF scores were also suggestive of specific personality traits associated with the predisposition towards psychosomatic disorders. However, no stress-related behaviors were observed with the PSQ. Rhinasthma highlighted a certain degree of the perceived quality of life. Additionally, the quality of life correlated with age, all psychological distress scales, a few personality traits, vigor, and stress disorders. CONCLUSIONS Allergic asthma patients present a higher-than-average level of psychological distress and impaired perceived quality of life at the time of diagnosis. Therefore, it is important to assess the psychological status in addition to the respiratory function.
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Cárdaba B, Pelaia G. Editorial: Impact of system biology and molecular medicine on the management of complex immune mediated respiratory diseases, volume II. Front Med (Lausanne) 2023; 10:1187941. [PMID: 37351067 PMCID: PMC10282990 DOI: 10.3389/fmed.2023.1187941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Affiliation(s)
- Blanca Cárdaba
- Immunology Department, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- Center for Biomedical Network of Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Girolamo Pelaia
- Department of Health Sciences, University “Magna Græcia” of Catanzaro, Catanzaro, Italy
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Blanco-Aparicio M, García-Río FJ, González-Barcala FJ, Jiménez-Ruiz CA, Muñoz X, Plaza V, Soto-Campos JG, Urrutia-Landa I, Almonacid C, Peces-Barba G, Álvarez-Gutiérrez FJ. [A Study of the Prevalence of Asthma in the General Population in Spain]. OPEN RESPIRATORY ARCHIVES 2023; 5:100245. [PMID: 37496876 PMCID: PMC10369549 DOI: 10.1016/j.opresp.2023.100245] [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: 02/05/2023] [Accepted: 03/29/2023] [Indexed: 07/28/2023] Open
Abstract
Introduction Asthma is a disease with high prevalence, which affects all age groups and generates high health and social care costs. Studies carried out in a number of populations show great variability in its prevalence, even in geographically close populations, with data suggesting a relevant influence of socio-economic factors. At present, we do not have reliable data on the prevalence of this disease in the adult population of Spain. The objectives of this study are to estimate the prevalence of asthma in the Spanish population for those aged 18-79, to describe the variability between autonomous communities, to estimate the prevalence of under and overdiagnosis, to analyse the prevalence of uncontrolled asthma and steroid-dependent asthma, to evaluate the health care cost, to identify the most frequent phenotypes and to establish a starting point to evaluate the temporal trend with subsequent studies. Methods A cross-sectional, two-stage study will be carried out, including patients from 50 catchment areas. The study will be carried out in 3 phases: 1) screening and confirmation in the clinical history, in which patients with a previously correctly established diagnosis of asthma will be identified; 2) diagnosis of asthma to evaluate patients without a confirmed or excluded diagnosis; 3) characterization of asthma, where the characteristics of the asthmatic patients will be analysed, identifying the most frequent phenotypes. Discussion It seems necessary and feasible to carry out an epidemiological study of asthma in Spain to identify the prevalence of asthma, to optimize healthcare planning, to characterize the most frequent phenotypes of the disease, and to evaluate inaccurate diagnoses.
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Affiliation(s)
| | - Francisco José García-Río
- Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Madrid, España
- Universidad Autónoma de Madrid, Madrid, España
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, España
| | - Francisco Javier González-Barcala
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, España
- Grupo de Investigación Traslacional de Enfermedades de la Vía Aérea, Fundación Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, España
- Departamento de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, España
- Servicio de Neumología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | | | - Xavier Muñoz
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, España
- Servicio de Neumología, Hospital Vall d’Hebron, Barcelona, España
- Departamento de Biología Celular, Fisiología e Inmonología, Universidad Autónoma de Barcelona, Barcelona, España
| | - Vicente Plaza
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, España
- Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
- Institut de Investigació Biomèdica Sant Pau-IIB Sant Pau, Barcelona, España
- Departamento de Medicina, Universidad Autónoma de Barcelona, Barcelona, España
| | | | - Isabel Urrutia-Landa
- Servicio de Neumología, Hospital de Galdakao, Bizkaia, España
- Instituto de Investigación Sanitaria Biocruces, Bizkaia, España
| | - Carlos Almonacid
- Servicio de Neumología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Gregorio Peces-Barba
- Instituto de Investigación Sanitaria, Fundación Jiménez Díaz, Madrid, España
- Universidad Autónoma de Madrid, Madrid, España
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George M, Camargo CA, Burnette A, Chen Y, Pawar A, Molony C, Auclair M, Wells MA, Ferro TJ. Racial and Ethnic Minorities at the Highest Risk of Uncontrolled Moderate-to-Severe Asthma: A United States Electronic Health Record Analysis. J Asthma Allergy 2023; 16:567-577. [PMID: 37200709 PMCID: PMC10187653 DOI: 10.2147/jaa.s383817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/31/2023] [Indexed: 05/20/2023] Open
Abstract
Purpose The identification of risk factors associated with uncontrolled moderate-to-severe asthma is important to improve asthma outcomes. Aim of this study was to identify risk factors for uncontrolled asthma in United States cohort using electronic health record (EHR)-derived data. Patients and Methods In this retrospective real-world study, de-identified data of adolescent and adult patients (≥12 years old) with moderate-to-severe asthma, based on asthma medications within 12 months prior to asthma-related visit (index date), were extracted from the Optum® Humedica EHR. The baseline period was 12 months prior to the index date. Uncontrolled asthma was defined as ≥2 outpatient oral corticosteroid bursts for asthma or ≥2 emergency department visits or ≥1 inpatient visit for asthma. A Cox proportional hazard model was applied. Results There were 402,403 patients in the EHR between January 1, 2012, and December 31, 2018, who met the inclusion criteria and were analyzed. African American (AA) race (hazard ratio [HR]: 2.08), Medicaid insurance (HR: 1.71), Hispanic ethnicity (HR: 1.34), age of 12 to <18 years (HR 1.20), body mass index of ≥35 kg/m2 (HR: 1.20), and female sex (HR 1.19) were identified as risk factors associated with uncontrolled asthma (P < 0.001). Comorbidities characterized by type 2 inflammation, including a blood eosinophil count of ≥300 cells/μL (as compared with eosinophil <150 cells/μL; HR: 1.40, P < 0.001) and food allergy (HR: 1.31), were associated with a significantly higher risk of uncontrolled asthma; pneumonia was also a comorbidity associated with an increased risk (HR: 1.35) of uncontrolled asthma. Conversely, allergic rhinitis (HR: 0.84) was associated with a significantly lower risk of uncontrolled asthma. Conclusion This large study demonstrates multiple risk factors for uncontrolled asthma. Of note, AA and Hispanic individuals with Medicaid insurance are at a significantly higher risk of uncontrolled asthma versus their White, non-Hispanic counterparts with commercial insurance.
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Affiliation(s)
- Maureen George
- Office of Research and Scholarship, Columbia University School of Nursing, New York, NY, USA
- Correspondence: Maureen George, Office of Research and Scholarship, Columbia University School of Nursing, New York, NY, 10032, USA, Tel +1 212-305-1175, Email
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Autumn Burnette
- Division of Allergy and Immunology, Howard University Hospital, Howard University College of Medicine, Washington, DC, USA
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Tsegaye T, Gebretekle GB, Ahmed MH, Bayissa T, Habte BM. Asthma Treatment Outcome and Factors Associated with Uncontrolled Asthma Among Adult Patients with Asthma in Addis Ababa, Ethiopia. J Asthma Allergy 2022; 15:1055-1063. [PMID: 35983570 PMCID: PMC9381014 DOI: 10.2147/jaa.s373479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Asthma is a major public health challenge in the world resulting in significant health and economic burden. The modifiable and non-modifiable risk factors could have considerable impact on asthma control and medical care. Objective This study is intended to evaluate the treatment outcome and identify risk factors for poor asthma control among patients with asthma in Addis Ababa, Ethiopia. Methods A multicentre cross-sectional study using interview and chart review was conducted among patients with asthma attending ambulatory care of two large public hospitals in Addis Ababa, Ethiopia, between March and June 2018. The Global Initiative for Asthma Guideline was used to determine treatment outcomes. The variables of interest were described using descriptive statistics such as frequencies, percentages, mean, and standard deviations. Multivariable logistic regression was used to determine factors associated with uncontrolled asthma. All statistical significance level was determined at p < 0.05. Results A total of 230 patients with asthma were interviewed. More than half (65.2%) of patients were females, and their mean age was 54 ± 15.1 years. Overall, 50.4% of the patients had uncontrolled asthma status. More than two number of trigger factors (AOR = 1.88; 95% CI: 1.09-2.01), cold weather (AOR = 2.11; 95% CI: 1.51-2.42), exacerbations of asthma in the last 12 months (AOR = 2.01; 95% CI: 1.39-2.32), moderate persistent asthma (AOR = 3.47; 95% CI: 1.75-5.13), severe persistent asthma (AOR = 2.90; 95% CI: 2.56-3.98), patients on Salbutamol puff with Beclomethasone (AOR = 2.92; 95% CI: 2.50-3.45) and patients on Salbutamol puff with Beclomethasone and Prednisolone (AOR = 5.76; 95% CI: 4.02-6.02) use were significantly associated with uncontrolled asthma. Conclusion More than half of patients with asthma had uncontrolled asthma treatment outcome. This indicates the need to give due attention to asthma patients with uncontrolled status, particularly to those with identified risk factors. Health care providers should work in creating patient awareness on appropriate use of their prescribed medications, avoidance of asthma triggering factors for decreasing the progression of the disease and better asthma control.
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Affiliation(s)
| | - Gebremedhin Beedemariam Gebretekle
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Canada
| | | | - Tola Bayissa
- Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Bruck Messele Habte
- School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Stepped treatment algorithm using budesonide-formoterol for chronic respiratory diseases: A single arm interventional study. PLoS One 2022; 17:e0271178. [PMID: 35816478 PMCID: PMC9273083 DOI: 10.1371/journal.pone.0271178] [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: 05/08/2021] [Accepted: 06/24/2022] [Indexed: 11/20/2022] Open
Abstract
Background While the safety and efficacy of inhaled budesonide-formoterol, used as-needed for symptoms, has been established for patients with asthma, it has not been trialed in undifferentiated patients with chronic respiratory diseases. We aimed to assess the feasibility of a pragmatic intervention that entails a stepped algorithm using inhaled budesonide-formoterol (dry powder inhaler, 160μg/4.5μg per dose) for patients presenting with chronic respiratory diseases to three rural district hospitals in Hanoi, Vietnam. Methods We recruited patients with evidence of airflow obstruction on spirometry and/or symptoms consistent with asthma. The algorithm consisted of three steps: 1. as-needed inhaled budesonide-formoterol for symptoms, 2. maintenance plus as-needed inhaled budesonide-formoterol, and 3. referral to a higher-level healthcare facility. All participants started at step 1, with escalation to the next step at review visits if there had been exacerbation(s) or inadequate symptom control. Patients were followed for 12 months. Results Among 313 participants who started the treatment algorithm, 47.2% had ≥ 1 episode of acute respiratory symptoms requiring a visit to hospital or clinic and 35.4% were diagnosed with an exacerbation. Twelve months after enrolment, 50.7% still adhered to inhaled budesonide-formoterol at the recommended treatment step. The mean and median number of doses per day was 1.5 (standard deviation 1.2) doses and 1.3 (interquartile range 0.7–2.3) doses, respectively. The proportion of patients taking more than 800μg budesonide per day was 3.8%. Conclusion This novel therapeutic algorithm is feasible for patients with chronic respiratory diseases in a rural setting in Vietnam. Further studies are required to establish the effectiveness, safety and cost-effectiveness of similar approaches in different settings. Trial registration ACTRN12619000554167.
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10
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Yuan HK, Lu J, Wang XL, Lv ZY, Li B, Zhu W, Yang YQ, Yin LM. The Effects of a Transgelin-2 Agonist Administered at Different Times in a Mouse Model of Airway Hyperresponsiveness. Front Pharmacol 2022; 13:873612. [PMID: 35784706 PMCID: PMC9243334 DOI: 10.3389/fphar.2022.873612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
Airway hyperresponsiveness (AHR) is one of the most important features of asthma. Our previous study showed that inhaled transgelin-2 agonist, TSG12, effectively reduced pulmonary resistance in a mouse model of asthma in a dose-dependent manner. However, the optimal administration time of TSG12 to reduce AHR and the pharmacological effects are still unclear. In this study, the effects of TSG12 inhalation before and during AHR occurrence were examined. The results showed that the pulmonary resistance was reduced by 57% and the dynamic compliance was increased by 46% in the TSG12 Mch group (atomize TSG12 10 min before methacholine, p < 0.05 vs. model). The pulmonary resistance was reduced by 61% and the dynamic compliance was increased by 47% in the TSG12 + Mch group (atomize TSG12 and methacholine together, p < 0.05 vs. model). Quantitative real-time PCR showed that the gene expression levels of transgelin-2, myosin phosphatase target subunit-1, and myosin light chain were up-regulated by 6.4-, 1.9-, and 2.8-fold, respectively, in the TSG12 Mch group. The gene expression levels of transgelin-2, myosin phosphatase target subunit-1, and myosin light chain were up-regulated by 3.2-, 1.4-, and 1.9-fold, respectively, in the TSG12 + Mch group. The results suggested that TSG12 effectively reduces pulmonary resistance when TSG12 inhalation occurred both before and during AHR occurrence. Gene expression levels of transgelin-2 and myosin light chain were significantly up-regulated when TSG12 inhalation occurred before AHR occurrence. This study may provide a basis for the administration time of TSG12 for asthma treatment in the future.
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Affiliation(s)
- Hong-Kai Yuan
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jin Lu
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xue-Ling Wang
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhi-Ying Lv
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bo Li
- CAS Key Laboratory of Receptor Research, State Key Laboratory of Drug Research, Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Weiliang Zhu
- CAS Key Laboratory of Receptor Research, State Key Laboratory of Drug Research, Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Yong-Qing Yang
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Yong-Qing Yang, ; Lei-Miao Yin,
| | - Lei-Miao Yin
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Yong-Qing Yang, ; Lei-Miao Yin,
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11
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Ragnoli B, Morjaria J, Pignatti P, Montuschi P, Barbieri M, Mondini L, Ruggero L, Trotta L, Malerba M. Dupilumab and tezepelumab in severe refractory asthma: new opportunities. Ther Adv Chronic Dis 2022; 13:20406223221097327. [PMID: 35655942 PMCID: PMC9152192 DOI: 10.1177/20406223221097327] [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: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
Bronchial asthma is a chronic inflammatory condition with increasing prevalence worldwide that may present as heterogeneous phenotypes defined by the T2-mediated pattern of airway inflammation T2-high and T2-low asthma. Severe refractory asthma includes a subset of asthmatic patients who fail to control their disease despite maximal therapy and represent a group of patients needing marked resource utilization and hence may be eligible to add-on biological therapies. Among the new biologics, we focused our attention on two monoclonal antibodies: dupilumab, exerting a dual blockade of cytokine (interleukin (IL)-4 and IL-13) signaling; and tezepelumab, acting at a higher level preventing the binding of thymic stromal lymphopoietin (TSLP) to its receptor, thus blocking TSLP, IL-25, and IL-33 signaling, hence modulating airway T2 immune responses. With their different mechanisms of action, these two biologics represent important options to provide an enhanced personalized treatment regimen. Several clinical trials have been conducted testing the efficacy and safety of dupilumab in severe refractory asthmatic patients showing improvements in lung function, asthma control, and reducing exacerbations. Similar results were reported with tezepelumab that, differently from dupilumab, acts irrespectively on eosinophilic or non-eosinophilic phenotype. In this review, we provide an overview of the most important highlights regarding dupilumab and tezepelumab characteristics and mechanism of action with a critical review of the principal results of clinical (Phase II and III) studies concluded and those still in progress.
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Affiliation(s)
| | - Jaymin Morjaria
- Department of Respiratory Medicine, Harefield Hospital, Guy’s & St Thomas’ NHS Foundation Trust, Harefield, UK
| | - Patrizia Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri IRCCS Pavia, Pavia, Italy
| | - Paolo Montuschi
- Pharmacology Department, Faculty of Medicine, Catholic University of the Sacred Heart, Milan, Italy
- Airways Disease Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College of Science Technology and Medicine, London, UK
| | | | | | - Luca Ruggero
- Respiratory Unit, S. Andrea Hospital, Vercelli, Italy
| | | | - Mario Malerba
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Respiratory Unit, S. Andrea Hospital, Vercelli, Italy
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12
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Aschalew A, Kebed RA, Demie TG, Weldetsadik AY. Assessment of level of asthma control and related factors in children attending pediatric respiratory clinics in Addis Ababa, Ethiopia. BMC Pulm Med 2022; 22:70. [PMID: 35197032 PMCID: PMC8865488 DOI: 10.1186/s12890-022-01865-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Asthma is a common airways disease with significant morbidity and mortality in all ages. Studies of pediatric asthma control and its determinants yielded variable results across settings. However, there is paucity of data on asthma control and its factors in Ethiopian children. We aimed to assess the level of asthma control and the related factors in children attending pediatric respiratory clinics at three tertiary hospitals in Addis Ababa.
Methods We conducted a cross-sectional study from March 1 to August 30, 2020 using standardized questionnaires and review of patient’s charts. Data was analyzed using SPSS software for window version 26. Results A total of 105 children (56.2% male) were included in the study. The mean age (± SD) and age at Asthma diagnosis (± SD) were 6 (± 3.3) and 4 (± 2.8) respectively. Uncontrolled asthma was present in 33 (31%) of children. Comorbidities (Atopic dermatitis and allergic Rhinitis (AOR = 4.56; 95% CI 1.1–18.70; P = 0.035), poor adherence to controller medications (AOR = 3.23; 95% CI 1.20–10.20; P = 0.045), inappropriate inhaler technique (AOR = 3.48; 95% CI 1.18–10.3; P = 0.024), and lack of specialized care (AOR = 4.72; 95% CI 1.13–19.80; P = 0.034) were significantly associated with suboptimal asthma control. Conclusion One-third of children attending pediatric respiratory clinics in Addis Ababa had uncontrolled Asthma. Treatment of comorbidities, training of appropriate inhaler techniques, optimal adherence to controllers, and proper organization of clinics should be emphasized to improve asthma control among children.
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Affiliation(s)
| | - Rahel Argaw Kebed
- Pediatric Pulmonary and Critical Care, Addis Ababa University, Addis Ababa, Ethiopia
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13
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Mulugeta T, Ayele T, Zeleke G, Tesfay G. Asthma control and its predictors in Ethiopia: Systematic review and meta-analysis. PLoS One 2022; 17:e0262566. [PMID: 35025962 PMCID: PMC8758033 DOI: 10.1371/journal.pone.0262566] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Determining the status of asthma control and identifying risk factors for poor asthma control is a key strategy for curbing the negative health impacts and the financial burden of the disease. Therefore, this review was aimed to determine the rate of asthma control and assess the predictors of uncontrolled asthma in Ethiopia. METHODS PubMed, Web of Science, and Google Scholar searches were performed using key terms; "asthma, bronchial asthma, control, controlled, uncontrolled and Ethiopia" up to October 16, 2020. University repositories were also searched to retrieve gray literature. The results were presented as a prevalence rate with a 95% confidence interval (CI). Subgroup analysis and meta-regression were performed to identify the sources of heterogeneity in the outcomes. RESULTS From 1,388 patients, based on the Global Initiative for Asthma (GINA) symptom control, the rate of the uncontrolled asthma was 45.0% (95% CI 34.0% - 56.0%) with a considerable heterogeneity between the studies; (I2: 94.55, p< 0.001). About 19.0% (95% CI 10.0% - 29.0%); (I2: 96.04, p< 0.001) of the asthma patients had a well-controlled asthma. Moreover, 36.0% (95% CI 22.0% - 50.0%), (I2: 97.11, p< 0.001) of patients had a partly controlled asthma. Similarly, based on the asthma control test (ACT), the rate of well-controlled asthma was 22.0% (95% CI 3% - 42.0%), with considerable heterogeneity between the studies; (I2: 97.75, p< 0.001). The most frequent predictors of uncontrolled asthma were incorrect inhalation techniques, frequent SABA use, moderate/severe persistent asthma, history of exacerbations, presence of comorbidities, use of oral corticosteroids, and irregular follow-up. CONCLUSION The rate of uncontrolled asthma in Ethiopia was high. Several factors are associated with uncontrolled asthma. Comprehensive asthma educations at each follow-up visit should be strengthened to minimize the morbidity and the cost of uncontrolled asthma.
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Affiliation(s)
- Temesgen Mulugeta
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
- * E-mail:
| | - Teshale Ayele
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getandale Zeleke
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Gebremichael Tesfay
- Department of Clinical Pharmacy, School of Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
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14
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Nayak AP, Deshpande DA, Shah SD, Villalba DR, Yi R, Wang N, Penn RB. OGR1-dependent regulation of the allergen-induced asthma phenotype. Am J Physiol Lung Cell Mol Physiol 2021; 321:L1044-L1054. [PMID: 34668419 PMCID: PMC8715030 DOI: 10.1152/ajplung.00200.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/10/2021] [Accepted: 10/15/2021] [Indexed: 11/22/2022] Open
Abstract
The proton-sensing receptor, ovarian cancer G protein-coupled receptor (OGR1), has been shown to be expressed in airway smooth muscle (ASM) cells and is capable of promoting ASM contraction in response to decreased extracellular pH. OGR1 knockout (OGR1KO) mice are reported to be resistant to the asthma features induced by inhaled allergen. We recently described certain benzodiazepines as OGR1 activators capable of mediating both procontractile and prorelaxant signaling in ASM cells. Here we assess the effect of treatment with the benzodiazepines lorazepam or sulazepam on the asthma phenotype in wild-type (WT) and OGR1KO mice subjected to inhaled house dust mite (HDM; Dermatophagoides pteronyssius) challenge for 3 wk. In contrast to previously published reports, both WT and OGR1KO mice developed significant allergen-induced lung inflammation and airway hyperresponsiveness (AHR). In WT mice, treatment with sulazepam (a Gs-biased OGR1 agonist), but not lorazepam (a balanced OGR1 agonist), prevented allergen-induced AHR, although neither drug inhibited lung inflammation. The protection from development of AHR conferred by sulazepam was absent in OGR1KO mice. Treatment of WT mice with sulazepam also resulted in significant inhibition of HDM-induced collagen accumulation in the lung tissue. These findings suggest that OGR1 expression is not a requirement for development of the allergen-induced asthma phenotype, but OGR1 can be targeted by the Gs-biased OGR1 agonist sulazepam (but not the balanced agonist lorazepam) to protect from allergen-induced AHR, possibly mediated via suppression of chronic bronchoconstriction and airway remodeling in the absence of effects on airway inflammation.
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Affiliation(s)
- Ajay P Nayak
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Deepak A Deshpande
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sushrut D Shah
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Dominic R Villalba
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Roslyn Yi
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nadan Wang
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Raymond B Penn
- Department of Medicine, Division of Pulmonary and Critical Care Medicine & Center for Translational Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Hu X, Deng S, Luo L, Jiang Y, Ge H, Yin F, Zhang Y, Zhang D, Li X, Feng J. GLCCI1 Deficiency Induces Glucocorticoid Resistance via the Competitive Binding of IRF1:GRIP1 and IRF3:GRIP1 in Asthma. Front Med (Lausanne) 2021; 8:686493. [PMID: 34504850 PMCID: PMC8421568 DOI: 10.3389/fmed.2021.686493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022] Open
Abstract
GLCCI1 plays a significant role in modulating glucocorticoid (GC) sensitivity in asthma. This project determines the underlying mechanism that GLCCI1 deficiency attenuates GC sensitivity in dexamethasone (Dex)-treated Ovalbumin (OVA)-induced asthma mice and epithelial cells through upregulating binding of IRF1:GRIP1 and IRF3:GRIP1. Dexamethasone treatment led to less reduced inflammation, airway hyperresponsiveness, and activation of the components responsible for GC activity, as determined by decreased GR and glucocorticoid receptor interacting protein 1 (GRIP1) expression but augmented IRF1 and IRF3 expression in GLCCI1−/− asthmatic mice compared with wild type asthmatic mice. Moreover, the recruitment of GRIP1 to GR was downregulated, while the individual recruitment of GRIP1 to IRF1 and IRF3 was upregulated in GLCCI1−/− Dex-treated asthmatic mice compared to wild type Dex-treated asthmatic mice. We also found that GLCCI1 knockdown reduced GR and GRIP1 expression but increased IRF1 and IRF3 expression in Beas2B and A549 cells. Additionally, GLCCI1 silencing increased the interactions between GRIP1 with IRF1 and GRIP1 with IRF3, but decreased the recruitment of GRIP1 to GR. These studies support a critical but previously unrecognized effect of GLCCI1 expression on epithelial cells in asthma GC responses by which GLCCI1 deficiency reduces the GR and GRIP1 interaction but competitively enhances the recruitment of GRIP1 to IRF1 and IRF3.
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Affiliation(s)
- Xinyue Hu
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Shuanglinzi Deng
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Lisha Luo
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Yuanyuan Jiang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Huan Ge
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Feifei Yin
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Yingyu Zhang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Daimo Zhang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaozhao Li
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, China
| | - Juntao Feng
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, China
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16
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Venkitakrishnan R, Cleetus M, Augustine J, Ramachandran D, John S, Vijay A, Nirmal AS, Sasi A, Kuriachen E. Acceptance and Results of Therapy with Omalizumab in Real world Kerala setting - Reports from the ARTWORK study, Kerala, South India. J Asthma 2021; 59:1831-1838. [PMID: 34388058 DOI: 10.1080/02770903.2021.1968425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite the availability of effective medications, only a minority of asthma patients achieve guideline defined asthma control. Treatment success depends on patient concurrence to the prescribed drug and adherence to treatment. It is therefore crucial to identify the patient preferences as well as attitudes towards asthma medications. Omalizumab is recommended as a preferred option in step five of asthma therapy. There have been few studies to address patient perspectives on omalizumab therapy in India. METHODS This was a retrospective study. Patients with inadequate asthma control were considered for the study. Systematic evaluation was done to identify and correct modifiable factors that can worsen asthma control. Patients with persisting poor asthma control who were deemed suitable to receive this agent were evaluated with their attitudes towards acceptance or refusal and the reasons for opting out were noted. The patients who received omalizumab were followed up to determine the results of treatment and duration of adherence to therapy. RESULTS 35 patients out of 51 patients chose to avoid this drug. The reasons for opting out included erroneous perception of optimal asthma control, cost of therapy, and concern about adverse effects. Patients took omalizumab for a median duration of 6 months. Improved asthma control and decreased frequency of exacerbation was noted in all patients which persisted during the six month follow up. CONCLUSIONS Majority of patients needing step five therapy opt out of omalizumab. Cost of drug, duration of therapy and erroneous perception of good asthma control account for refusing treatment. Omalizumab affords excellent clinical benefits to patients who receive it, and the benefits extend beyond the duration of therapy.
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Affiliation(s)
| | - Melcy Cleetus
- Rajagiri Hospital, Pulmonary medicine, Aluva, 683112 India
| | | | | | - Susan John
- Rajagiri Hospital, Clinical Epidemiology, Aluva, 683112 India
| | - Anand Vijay
- Rajagiri Hospital, Pulmonary medicine, Aluva, 683112 India
| | | | - Anju Sasi
- Rajagiri Hospital, Pulmonary medicine, Aluva, 683112 India
| | - Elda Kuriachen
- Rajagiri Hospital, Pulmonary medicine, Aluva, 683112 India
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17
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Averell CM, Laliberté F, Germain G, Duh MS, Lima R, Mahendran M, Slade DJ. Symptom control in patients with asthma using inhaled corticosteroids/long-acting β 2-agonists (fluticasone furoate/vilanterol or budesonide/formoterol) in the US: a retrospective matched cohort study. J Asthma 2021; 59:1805-1818. [PMID: 34375568 DOI: 10.1080/02770903.2021.1963767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Treatment with fluticasone furoate/vilanterol (FF/VI), an inhaled corticosteroid/long-acting β2-agonist therapy, reduces the risk of severe asthma exacerbations and improves lung function and symptom control in patients with asthma. However, real-world data remain limited among asthma patients in the United States (US).Methods: This retrospective cohort study propensity score (PS) matched adult asthma patients initiating once-daily FF/VI 100/25 mcg with patients initiating twice-daily budesonide/formoterol (B/F) 160/4.5 mcg using a US claims database (01/01/2015-12/31/2018). Asthma control was measured by the mean number of short-acting β2-agonist (SABA) canisters dispensed per patient-year (PPY) during follow-up. Time to first, and rates of, overall and severe asthma exacerbations were also measured.Results: After PS matching, 18531 patients receiving FF/VI were matched to 18531 patients receiving B/F. Mean SABA canisters dispensed PPY was significantly lower for FF/VI compared with B/F users (FF/VI: 1.47, B/F: 1.64; p < 0.001). FF/VI use resulted in 13% significantly lower risk of having an overall asthma-related exacerbation and 22% lower risk of a severe exacerbation versus B/F use (overall exacerbation hazard ratio [HR] [95% confidence interval (CI)]: 0.87 [0.82-0.92], p < 0.001; severe exacerbation HR: 0.78 [0.63-0.97], p = 0.027). Asthma-related exacerbation rates per 100 patient-days were also significantly lower for the FF/VI compared with B/F group (overall: 0.0475 vs. 0.0558, p < 0.001; severe 0.0026 vs. 0.0033, p = 0.020).Conclusions: In real-world practice, initiation of once-daily FF/VI 100/25 mcg in adults with asthma was associated with lower use of SABA and fewer asthma-related exacerbations, which may indicate better asthma control, when compared with use of twice-daily B/F 160/4.5 mcg.
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Affiliation(s)
- Carlyne M Averell
- US Value, Evidence and Outcomes, GlaxoSmithKline plc, Research Triangle Park, NC, United States
| | - François Laliberté
- Health Economics and Outcomes Research; Groupe d'analyses, Ltée, Montréal, QC, Canada
| | - Guillaume Germain
- Health Economics and Outcomes Research; Groupe d'analyses, Ltée, Montréal, QC, Canada
| | - Mei Sheng Duh
- Health Economics and Outcomes Research, Analysis Group, Inc, Boston, MA, United States
| | - Robson Lima
- US Medical Affairs, GlaxoSmithKline plc, Research Triangle Park, NC, United States
| | - Malena Mahendran
- Health Economics and Outcomes Research; Groupe d'analyses, Ltée, Montréal, QC, Canada
| | - David J Slade
- Clinical Sciences, GlaxoSmithKline plc, Research Triangle Park, NC, United States
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18
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Zhang L, Gao Y, Li M, Xu C, Davis JD, Kanamaluru V, Lu Q. Population pharmacokinetic analysis of dupilumab in adult and adolescent patients with asthma. CPT-PHARMACOMETRICS & SYSTEMS PHARMACOLOGY 2021; 10:941-952. [PMID: 34313019 PMCID: PMC8376131 DOI: 10.1002/psp4.12667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022]
Abstract
A population pharmacokinetic model was developed using data from healthy subjects and patients with moderate‐to‐severe asthma receiving intravenous or subcutaneous dupilumab doses. A total of nine phase I to phase III studies were pooled (202 healthy subjects and 1912 patients with asthma including 68 adolescents) in the model development. The best model was a two‐compartment model with parallel linear and nonlinear Michaelis–Menten elimination with first order absorption. The PK parameter estimates were distribution volume of central compartment 2.76 L, linear elimination rate 0.0418 1/day, and subcutaneous bioavailability 60.9%. Pharmacokinetics (PK) properties of dupilumab in patients with asthma were determined to be comparable to those of healthy subjects and patients with atopic dermatitis. Only body weight exerts a notable effect explaining between‐subject variability in dupilumab PK, but dose adjustment for weight is not warranted based on results from clinical studies. There is no PK difference between adolescent and adult patients with asthma after correction for body weight.
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Affiliation(s)
- Li Zhang
- Sanofi, Bridgewater, New Jersey, USA
| | - Yue Gao
- Sanofi, Bridgewater, New Jersey, USA
| | - Meng Li
- Sanofi, Bridgewater, New Jersey, USA
| | | | - John D Davis
- Regeneron Pharmaceuticals, Inc., Tarrytown, New York, USA
| | | | - Qiang Lu
- Sanofi, Bridgewater, New Jersey, USA
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19
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Prevention and Outpatient Treatment of Asthma Exacerbations in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2567-2576. [PMID: 34246433 DOI: 10.1016/j.jaip.2021.03.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 12/17/2022]
Abstract
Acute exacerbations cause significant morbidity and mortality in children with asthma worldwide. Although exacerbations can be minor and transient, in some children they are recurrent and significantly adversely impact quality of life. Children with frequent exacerbations account for a disproportionate amount of unscheduled care in nonprimary health facilities. Frequent exacerbators are often prescribed controller medications, but poor adherence is common. Major predictors for asthma exacerbations include genetic, social, comorbid, biological, and environmental factors. Although virus infections are a key trigger for exacerbations, other environmental factors also significantly increase risk. A previous exacerbation is a major risk factor for future exacerbations and thus identifies children to target for prevention of future episodes. In this review, we discuss both modifiable and fixed factors associated with asthma exacerbations, how to assess children for risk, and which pharmacological and nonpharmacological interventions may be of benefit. Finally, we review the current evidence around treatment within the outpatient setting for an emerging exacerbation.
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20
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Nayak AP, Lim JM, Arbel E, Wang R, Villalba DR, Nguyen TL, Schaible N, Krishnan R, Tang DD, Penn RB. Cooperativity between β-agonists and c-Abl inhibitors in regulating airway smooth muscle relaxation. FASEB J 2021; 35:e21674. [PMID: 34115899 DOI: 10.1096/fj.202100154r] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 01/29/2023]
Abstract
Current therapeutic approaches to avoid or reverse bronchoconstriction rely primarily on β2 adrenoceptor agonists (β-agonists) that regulate pharmacomechanical coupling/cross bridge cycling in airway smooth muscle (ASM). Targeting actin cytoskeleton polymerization in ASM represents an alternative means to regulate ASM contraction. Herein we report the cooperative effects of targeting these distinct pathways with β-agonists and inhibitors of the mammalian Abelson tyrosine kinase (Abl1 or c-Abl). The cooperative effect of β-agonists (isoproterenol) and c-Abl inhibitors (GNF-5, or imatinib) on contractile agonist (methacholine, or histamine) -induced ASM contraction was assessed in cultured human ASM cells (using Fourier Transfer Traction Microscopy), in murine precision cut lung slices, and in vivo (flexiVent in mice). Regulation of intracellular signaling that regulates contraction (pMLC20, pMYPT1, pHSP20), and actin polymerization state (F:G actin ratio) were assessed in cultured primary human ASM cells. In each (cell, tissue, in vivo) model, c-Abl inhibitors and β-agonist exhibited additive effects in either preventing or reversing ASM contraction. Treatment of contracted ASM cells with c-Abl inhibitors and β-agonist cooperatively increased actin disassembly as evidenced by a significant reduction in the F:G actin ratio. Mechanistic studies indicated that the inhibition of pharmacomechanical coupling by β-agonists is near optimal and is not increased by c-Abl inhibitors, and the cooperative effect on ASM relaxation resides in further relaxation of ASM tension development caused by actin cytoskeleton depolymerization, which is regulated by both β-agonists and c-Abl inhibitors. Thus, targeting actin cytoskeleton polymerization represents an untapped therapeutic reserve for managing airway resistance.
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Affiliation(s)
- Ajay P Nayak
- Department of Medicine, Pulmonary and Critical Care Medicine, Center for Translational Medicine, Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - John M Lim
- Department of Medicine, Pulmonary and Critical Care Medicine, Center for Translational Medicine, Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eylon Arbel
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, USA
| | - Ruping Wang
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, USA
| | - Dominic R Villalba
- Department of Medicine, Pulmonary and Critical Care Medicine, Center for Translational Medicine, Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Tahn L Nguyen
- Department of Medicine, Pulmonary and Critical Care Medicine, Center for Translational Medicine, Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Niccole Schaible
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ramaswamy Krishnan
- Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dale D Tang
- Department of Molecular and Cellular Physiology, Albany Medical College, Albany, NY, USA
| | - Raymond B Penn
- Department of Medicine, Pulmonary and Critical Care Medicine, Center for Translational Medicine, Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA, USA
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21
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Håkansson KEJ, Backer V, Suppli Ulrik C. Socioeconomic biases in asthma control and specialist referral of possible severe asthma. Eur Respir J 2021; 58:13993003.00741-2021. [PMID: 33986027 DOI: 10.1183/13993003.00741-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/03/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although socioeconomic impact on asthma control has been investigated, little is known about its relation to specialist referral of patients with possible severe asthma, especially in a public healthcare setting. The present study aims to identify socioeconomic patterns in disease control and referral of patients with asthma in a nationwide cohort of adult patients treated with inhaled corticosteroid (ICS). METHODS Asthma patients fulfilling the following: aged 18-45 and redeeming ≥2 prescriptions of ICS during 2014-18 based on data from Danish national registers were included. Possible severe asthma was defined as GINA 2020 Step 4 (with either ≥2 courses of systemic steroids or ≥1 hospitalisation) or Step 5 treatment. Findings presented as odds ratio (OR) (95% confidence intervals). RESULTS Of 60 534 patients (median age 34, 55% female), 3275 (5.7%) were deemed as having possible severe asthma, of whom 61% were managed in primary care alone.Odds of specialist management for possible severe asthma decreased with age (OR 0.66 (0.51-0.85)), 36-45 versus 18-25 years), male sex (OR 0.75 (0.64-0.87)), residence outside the Capital Region (OR 0.70 (0.59-0.82)) and with receiving unemployment or disability benefits OR 0.75 (0.59-0.95)).Having completed higher education increased odds of specialist referral (OR 1.28 (1.03-1.59)), when compared to patients with basic education. CONCLUSION Even in settings with nationally available free access to specialist care, the majority of patients with possible severe asthma are managed in primary care. Referral of at-risk asthma patients differs across socioeconomic parameters, calling for initiatives to identify and actively refer these patients.
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Affiliation(s)
| | - Vibeke Backer
- Centre for Physical Activity Research (CFAS), Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of ENT, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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22
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Ilmarinen P, Stridsman C, Bashir M, Tuomisto LE, Vähätalo I, Goksör E, Kankaanranta H, Backman H, Langhammer A, Piirilä P, Rönmark E, Lundbäck B, Nwaru BI, Wennergren G. Level of education and asthma control in adult-onset asthma. J Asthma 2021; 59:840-849. [PMID: 33497270 DOI: 10.1080/02770903.2021.1871742] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Education in itself and as a proxy for socioeconomic status, may influence asthma control, but remains poorly studied in adult-onset asthma. Our aim was to study the association between the level of education and asthma control in adult-onset asthma. METHODS Subjects with current asthma with onset >15 years were examined within the Obstructive Lung Disease in Northern Sweden study (OLIN, n = 593), Seinäjoki Adult Asthma Study (SAAS, n = 200), and West Sweden Asthma Study (WSAS, n = 301) in 2009-2014 in a cross-sectional setting. Educational level was classified as primary, secondary and tertiary. Uncontrolled asthma was defined as Asthma Control Test (ACT) score ≤19. Altogether, 896 subjects with complete data on ACT and education were included (OLIN n = 511, SAAS n = 200 and WSAS n = 185). RESULTS In each cohort and in pooled data of all cohorts, median ACT score was lower among those with primary education than in those with secondary and tertiary education. Uncontrolled asthma was most common among those with primary education, especially among daily ICS users (42.6% primary, 28.6% secondary and 24.2% tertiary; p = 0.001). In adjusted analysis, primary education was associated with uncontrolled asthma in daily ICS users (OR 1.92, 95% CI 1.15-3.20). When stratified by atopy, the association between primary education and uncontrolled asthma was seen in non-atopic (OR 3.42, 95% CI 1.30-8.96) but not in atopic subjects. CONCLUSIONS In high-income Nordic countries, lower educational level was a risk factor for uncontrolled asthma in subjects with adult-onset asthma. Educational level should be considered in the management of adult-onset asthma.
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Affiliation(s)
- Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Caroline Stridsman
- Department of Public Health and Clinical Medicine, Division of Medicine, The OLIN unit, Umeå University, Umeå, Sweden
| | - Muwada Bashir
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Iida Vähätalo
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Emma Goksör
- Department of Paediatrics, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Helena Backman
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden
| | - Arnulf Langhammer
- Department of Public Health and Nursing, HUNT Research Centre, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Levanger, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Päivi Piirilä
- Unit of Clinical Physiology, HUS Medical Diagnostic Center, Helsinki University Central Hospital, Helsinki, Finland.,University of Helsinki, Helsinki, Finland
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Section of Sustainable Health, The OLIN unit, Umeå University, Umeå, Sweden
| | - Bo Lundbäck
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Bright I Nwaru
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Wallenberg Center for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Göran Wennergren
- Krefting Research Center, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.,Department of Paediatrics, University of Gothenburg, Queen Silvia Children's Hospital, Gothenburg, Sweden
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23
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Bosi A, Tonelli R, Castaniere I, Clini E, BeghÈ B. Acute severe asthma: management and treatment. Minerva Med 2021; 112:605-614. [PMID: 33634676 DOI: 10.23736/s0026-4806.21.07372-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Patients with acute asthma attack usually access the emergency room with severe functional impairment, despite low perception of symptoms. In this scenario, early functional assessment is essential focusing on vital parameters and respiratory function, alongside perceived dyspnea. Impairment of ventilatory mechanics due to progressive dynamic pulmonary hyperinflation should be promptly treated with medical inhalation and/or intravenous therapy, reserving intensive treatment in case of non-response and/or worsening of the clinical conditions. Therapeutic planning at patient's discharge is no less important than treatment management during emergency room access as educating the patient about therapeutic adherence significantly impact long-term outcomes of asthma. With this review we aim at exploring current evidence on acute asthma attack management, focusing of pharmacological and ventilatory strategies of care and highlighting the importance of patient education once clinical stability allows discharge from the emergency department.
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Affiliation(s)
- Annamaria Bosi
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy
| | - Roberto Tonelli
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy
| | - Ivana Castaniere
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena Reggio Emilia, Modena, Italy
| | - Enrico Clini
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy
| | - Bianca BeghÈ
- Respiratory Diseases Unit, University Hospital of Modena, Modena, Italy -
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24
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Özden Mat D, Firat S, Aksu K, Aksu F, Duyar SŞ. Obstructive sleep apnea is a determinant of asthma control independent of smoking, reflux, and rhinitis. Allergy Asthma Proc 2021; 42:e25-e29. [PMID: 33404398 DOI: 10.2500/aap.2021.42.200098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background: Asthma control is defined as to what extent manifestations of asthma can be observed in a patient or have been reduced or removed by treatment. Regular use of asthma treatments, correct inhaler technique, adequate information provided about the patient's diseases and medicines, and patient-clinician collaboration aid asthma control. Asthma shares risk factors and links in the pathogenesis with obstructive sleep apnea (OSA), and OSA may aggravate asthma symptoms. Objective: To assess the risk of OSA for asthma control. Methods: The study was carried out in subjects with asthma who were followed up at specific time points and who used asthma medication regularly and with an appropriate inhaler technique. An asthma control test and a questionnaire were used to determine the asthma control levels and OSA risk of the subjects. Results: With regard to the questionnaire scoring, 77 of 137 subjects with asthma had a low OSA risk and 60 had a high OSA risk. The proportion of the subjects with a high OSA risk (p < 0.001) and were smokers (p = 0.020) were significantly higher in the subjects with uncontrolled asthma than in those with controlled asthma. Logistic regression analysis showed that the variables that affect asthma control status were the risk of OSA and obesity. The subjects with a low OSA risk were more likely to have controlled asthma than those with a high OSA risk (odds ratio 7.896 [95% confidence interval, 2.902-21.487]; p < 0.001). Conclusion: In the subjects with asthma and who adhered to therapy and used inhalers with the correct technique, a high risk of OSA was associated with poor control of their asthma. This association was independent of other factors, including rhinitis, gastroesophageal reflux, and smoking.
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Affiliation(s)
- Dilber Özden Mat
- From the University of Health Sciences Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Chest Diseases, Ankara, Turkey
| | - Selma Firat
- From the University of Health Sciences Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Chest Diseases, Ankara, Turkey
| | - Kurtuluş Aksu
- University of Health Sciences Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Division of Immunulugy and Allergy, Department of Chest Diseases, Ankara, Turkey
| | - Funda Aksu
- From the University of Health Sciences Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Chest Diseases, Ankara, Turkey
| | - Sezgi Şahin Duyar
- From the University of Health Sciences Atatürk Chest Diseases and Chest Surgery Education and Research Hospital, Department of Chest Diseases, Ankara, Turkey
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25
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Kaplan A, Chang KL. Tiotropium in asthma - perspectives for the primary care physician. Postgrad Med 2020; 133:552-564. [PMID: 32896185 DOI: 10.1080/00325481.2020.1816329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Asthma is a heterogeneous disease characterized by airway inflammation resulting from complex interactions between multiple hosts as well as environmental factors. As a chronic respiratory condition, asthma exerts a significant impact on patients and the healthcare system. Per the Global Initiative for Asthma (GINA), inhaled corticosteroids (ICS) with/without long-acting beta2-agonists (LABAs) should be used as the preferred controllers for the management of asthma. Despite a range of therapeutic options, many patients with asthma remain uncontrolled, resulting in an increased risk of hospitalization and emergency room visits and a worsened quality of life. Tiotropium (Spiriva®, Boehringer Ingelheim Pharmaceuticals, Inc; 1.25 µg, two puffs, once daily), delivered via the Respimat® inhaler (Boehringer Ingelheim Pharmaceuticals, Inc.), was the first long-acting muscarinic antagonist to be approved as an add-on maintenance treatment option for patients with asthma aged ≥6 years at GINA steps 4 and 5. By binding to the muscarinic receptors M1 and M3 in the bronchial airways, tiotropium antagonizes the action of acetylcholine, leading to smooth muscle relaxation and reduced mucus secretion.The efficacy and safety of tiotropium add-on to ICS±LABA maintenance treatment have been evaluated in randomized controlled trials (RCTs) involving patients with a range of asthma severities (mild, moderate, and severe) and across age groups (children, adolescents, and adults). Add-on tiotropium was found to be well tolerated and efficacious in all RCTs. Moreover, the findings from real-world studies complement results from RCTs, showing beneficial effects of tiotropium in reducing exacerbations, hospitalization, emergency room visits, and asthma worsening.In this review article, we discuss the pathophysiology of asthma and the role of tiotropium in the management of asthma from the perspective of a primary care physician.
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Affiliation(s)
- Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Ku-Lang Chang
- Department of Community Health and Family Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
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26
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Teague WG. Pediatric Severe Asthma in the Era of Biologic Treatments. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2020; 33:118-120. [PMID: 32953228 DOI: 10.1089/ped.2020.1249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- W Gerald Teague
- Division of Respiratory Medicine, Allergy, Immunology, and Sleep, Charlottesville, Virginia, USA.,Department of Pediatrics, Child Health Research Center, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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27
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Mosnaim G, Huang H, Ariely R, DePietro M, Jiang M, Ramakrishnan K, Batista AE, Lang K, Near AM. Clinical and Economic Outcomes in Patients with Persistent Asthma Who Attain Healthcare Effectiveness and Data Information Set Measures. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:3443-3454.e2. [PMID: 32562878 DOI: 10.1016/j.jaip.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Attainment of asthma-specific US Healthcare Effectiveness Data and Information Set (HEDIS) quality measures may be associated with improved clinical outcomes and reduced economic burden. OBJECTIVE We examined the relationship between the attainment of HEDIS measures asthma medication ratio (AMR) and medication management for people with asthma (MMA) on clinical and economic outcomes. METHODS This retrospective claims database analysis linked to ambulatory electronic medical records enrolled US patients aged ≥5 years with persistent asthma between May 2015 and April 2017. The attainment of AMR ≥0.5 and MMA ≥75% was determined over a 1-year premeasurement period. Asthma exacerbations and asthma-related health care costs were evaluated during the subsequent 12-month measurement period, comparing patients attaining 1 or both measures with those not attaining either. RESULTS In total, 32,748 patients were included, 75.2% of whom attained AMR (n = 24,388) and/or MMA (n = 12,042) during the premeasurement period. Fewer attainers of 1 or more HEDIS measures had ≥1 asthma-related hospitalizations, emergency department visit, corticosteroid burst, or exacerbation (4.9% vs 7.3%; 9.6% vs 18.2%; 43.8% vs 51.6%; 14.3% vs 23.3%, respectively; all P < .001) compared with nonattainers. In adjusted analyses, HEDIS attainment was associated with a lower likelihood of exacerbations (odds ratio: 0.63, [95% confidence interval: 0.60-0.67]; P < .001). The attainment of ≥1 HEDIS measures lowered total and asthma-related costs, and asthma exacerbation-related health care costs per patient relative to nonattainers (cost ratio: 0.87, P < .001; 0.96, P = .02; and 0.59, P < .001, respectively). Overall and asthma-specific costs were lower for patients attaining AMR, but not MMA. CONCLUSIONS HEDIS attainment was associated with significantly improved asthma outcomes and lower asthma-specific costs.
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Affiliation(s)
- Giselle Mosnaim
- Department of Medicine, NorthShore University HealthSystem, Evanston, Ill
| | - Huan Huang
- Real World Insights, IQVIA, Cambridge, Mass
| | - Rinat Ariely
- Global HEOR, Teva Branded Pharmaceutical Products R&D Inc., West Chester, Pa.
| | - Michael DePietro
- Global Medical Affairs, Teva Branded Pharmaceutical Products R&D Inc., West Chester, Pa
| | - Miao Jiang
- Real World Insights, IQVIA, Cambridge, Mass
| | | | - Alberto E Batista
- Global HEOR, Teva Branded Pharmaceutical Products R&D Inc., West Chester, Pa
| | - Kathy Lang
- Real World Insights, IQVIA, Cambridge, Mass
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28
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Lu RA, Zeki AA, Ram-Mohan S, Nguyen N, Bai Y, Chmiel K, Pecic S, Ai X, Krishnan R, Ghosh CC. Inhibiting Airway Smooth Muscle Contraction Using Pitavastatin: A Role for the Mevalonate Pathway in Regulating Cytoskeletal Proteins. Front Pharmacol 2020; 11:469. [PMID: 32435188 PMCID: PMC7218099 DOI: 10.3389/fphar.2020.00469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
Despite maximal use of currently available therapies, a significant number of asthma patients continue to experience severe, and sometimes life-threatening bronchoconstriction. To fill this therapeutic gap, we examined a potential role for the 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) inhibitor, pitavastatin. Using human airway smooth muscle (ASM) cells and murine precision-cut lung slices, we discovered that pitavastatin significantly inhibited basal-, histamine-, and methacholine (MCh)-induced ASM contraction. This occurred via reduction of myosin light chain 2 (MLC2) phosphorylation, and F-actin stress fiber density and distribution, in a mevalonate (MA)- and geranylgeranyl pyrophosphate (GGPP)-dependent manner. Pitavastatin also potentiated the ASM relaxing effect of a simulated deep breath, a beneficial effect that is notably absent with the β2-agonist, isoproterenol. Finally, pitavastatin attenuated ASM pro-inflammatory cytokine production in a GGPP-dependent manner. By targeting all three hallmark features of ASM dysfunction in asthma—contraction, failure to adequately relax in response to a deep breath, and inflammation—pitavastatin may represent a unique asthma therapeutic.
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Affiliation(s)
- Robin A Lu
- Department of Emergency Medicine, Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Amir A Zeki
- Division of Pulmonary, Critical Care, and Sleep Medicine, U.C. Davis Lung Center, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Sumati Ram-Mohan
- Department of Emergency Medicine, Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Nhan Nguyen
- Department of Emergency Medicine, Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Yan Bai
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Kenneth Chmiel
- Division of Pulmonary, Critical Care, and Sleep Medicine, U.C. Davis Lung Center, University of California Davis School of Medicine, Sacramento, CA, United States
| | - Stevan Pecic
- Department of Chemistry and Biochemistry, California State University, Fullerton, CA, United States
| | - Xingbin Ai
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ramaswamy Krishnan
- Department of Emergency Medicine, Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Chandra C Ghosh
- Department of Emergency Medicine, Center for Vascular Biology Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
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29
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Castro M, Rabe KF, Corren J, Pavord ID, Katelaris CH, Tohda Y, Zhang B, Rice MS, Maroni J, Rowe P, Pirozzi G, Amin N, Ruddy M, Akinlade B, Graham NMH, Teper A. Dupilumab improves lung function in patients with uncontrolled, moderate-to-severe asthma. ERJ Open Res 2020; 6:00204-2019. [PMID: 32010719 PMCID: PMC6983496 DOI: 10.1183/23120541.00204-2019] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/13/2019] [Indexed: 01/07/2023] Open
Abstract
Background Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for interleukin-4 and interleukin-13, key drivers of type 2 inflammation. In the phase 3 LIBERTY ASTHMA QUEST trial (NCT02414854) in patients with uncontrolled, moderate-to-severe asthma, add-on dupilumab 200 mg or 300 mg every 2 weeks reduced exacerbations and improved forced expiratory volume in 1 s (FEV1) and quality of life over 52 weeks. This analysis evaluates dupilimab's effect on lung function in the overall population, and subgroups with baseline elevated type 2 inflammatory biomarkers. Methods Patients were randomised to 52 weeks of subcutaneous dupilumab 200 mg every 2 weeks, 300 mg every 2 weeks, or matched-volume placebos. Lung function outcomes were analysed in the overall population, in patients with ≥150 eosinophils·µL−1, ≥300 eosinophils·µL−1, ≥25 ppb fractional exhaled nitric oxide (FeNO), and both ≥150 eosinophils·µL−1 and ≥25 ppb FeNO, at baseline. Results Dupilumab treatment (200 mg and 300 mg every 2 weeks) resulted in significant improvements versus placebo after 52 weeks in pre-bronchodilator FEV1 (0.20 and 0.13 L, respectively, versus placebo) and post-bronchodilator FEV1 (0.19 and 0.13 L, respectively), forced vital capacity (FVC) (0.20 and 0.14 L, respectively), forced expiratory flow (0.19 and 0.13 L·s−1, respectively) and pre-bronchodilator FEV1/FVC ratio (1.75% and 1.61%, respectively) in the overall population (p<0.001). Difference versus placebo in post-bronchodilator FEV1 slope of change (weeks 4–52) was significant (0.04 L·year−1; p<0.05). Greater improvements were achieved in patients with elevated baseline blood eosinophil and/or FeNO levels for most outcomes. Conclusions Dupilumab improves lung function outcomes, including large and small airway measurements and fixed airway obstruction, in patients with uncontrolled, moderate-to-severe asthma; particularly in patients with elevated biomarkers of type 2 inflammation. Dupilumab is a fully human monoclonal antibody that blocks the shared receptor component for interleukin-4 and interleukin-13, key drivers of type 2 inflammation, improving lung function outcomes in patients with uncontrolled, moderate-to-severe asthmahttp://bit.ly/2OhKMpi
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Affiliation(s)
- Mario Castro
- Washington University School of Medicine, St Louis, MO, USA
| | - Klaus F Rabe
- LungenClinic Grosshansdorf and Christian Albrechts University, members of the German Center for Lung Research (DZL), Kiel, Germany
| | - Jonathan Corren
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ian D Pavord
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Constance H Katelaris
- Campbelltown Hospital, Campbelltown, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Yuji Tohda
- Dept of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | | | | | - Jaman Maroni
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
| | | | | | - Nikhil Amin
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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30
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Weinstein CLJ, Ryan N, Zhang X, Shekar T, Gates D, Lane SJ, Agache I, Nathan RA. Serious Asthma Outcomes and Asthma Exacerbations with Maintenance on Inhaled Corticosteroid (Mometasone Furoate)/Long-Acting Beta Agonist (Formoterol) Combination Compared to Step Down to Mometasone Monotherapy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1634-1644.e1. [PMID: 31981733 DOI: 10.1016/j.jaip.2020.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Because of historical safety concerns with the use of long-acting β-agonists (LABA) in asthma, step-down from inhaled corticosteroid (ICS)/LABA combination therapy to ICS monotherapy is recommended once asthma control is achieved. OBJECTIVE To evaluate the benefit/risk question about whether patients with asthma who achieve disease control on fixed-dose ICS/LABA combination therapy, such as mometasone furoate/formoterol fumarate (MF/F), should continue with this therapy or be stepped down to ICS monotherapy, such as MF. METHODS Using data from 8447 clinically stable patients with persistent asthma in the Safety Pharma Investigation of Respiratory Outcomes trial who had been receiving a stable dose of ICS/LABA for ≥4 weeks, this post hoc analysis evaluated the risk of serious asthma outcomes (SAOs) (adjudicated hospitalization, intubation, or death) and asthma exacerbation (AEX) (composite of hospitalizations ≥24 hours, emergency visits <24 hours requiring systemic corticosteroid, or systemic corticosteroid for ≥3 consecutive days) in participants randomized to remain on ICS/LABA (MF/F) or step down to ICS (MF) for 26 weeks. RESULTS There was no significant difference in SAO risk among patients maintained on ICS/LABA with MF/F compared with those who stepped down from ICS/LABA to MF (hazard ratio [HR], 1.03 [95% confidence interval (CI): 0.61, 1.75], P = .913). The risk of AEX was significantly lower in patients maintained on ICS/LABA with MF/F compared with those who stepped down from ICS/LABA to MF (HR, 0.87 [95% CI: 0.78, 0.98], P = .020). CONCLUSIONS In this post hoc analysis of a large clinical trial dataset, maintenance on ICS/LABA with MF/F is not associated with an increased risk of SAOs and also significantly reduces the risk of AEX compared with step-down from ICS/LABA to MF.
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Affiliation(s)
- Cindy L J Weinstein
- Respiratory and Immunology Clinical Development, Merck & Co., Inc., Kenilworth, NJ.
| | - Nicholas Ryan
- Clinical Sciences, Merck & Co., Inc., Kenilworth, NJ
| | | | - Tulin Shekar
- Biostatistics, Merck & Co., Inc., Kenilworth, NJ
| | - Davis Gates
- Biostatistics, Merck & Co., Inc., Kenilworth, NJ
| | - Stephen J Lane
- The Professional Respiratory Centre, Tallaght Hospital, Dublin, Ireland
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Robert A Nathan
- Asthma and Allergy Associates and Research Center, Colorado Springs, Colo
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31
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Müllerová H, Cockle SM, Gunsoy NB, Nelsen LM, Albers FC. Clinical characteristics and burden of illness among adolescent and adult patients with severe asthma by asthma control: the IDEAL study. J Asthma 2020; 58:459-470. [PMID: 31874051 DOI: 10.1080/02770903.2019.1708095] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Severe asthma (SA) can be uncontrolled despite guideline-directed treatment. We described SA characteristics and identified factors associated with uncontrolled disease and frequent exacerbations. METHODS Post hoc analysis of the observational IDEAL study (201722/NCT02293265) included patients with SA aged ≥12 years receiving high-dose inhaled corticosteroids plus additional controller(s) for ≥12 months. Uncontrolled SA was defined by Asthma Control Questionnaire (ACQ)-5 scores ≥1.5 or ≥1 exacerbations (prior year), and further stratified by exacerbation frequency (no/infrequent [0-1] vs frequent [≥2]; prior year); associated factors were determined using multivariate logistic regression. RESULTS Of 670 patients with SA, 540 (81%) were uncontrolled (ACQ-5 scores ≥1.5: 80%; ≥1 exacerbations [prior year]: 71%). Uncontrolled patients had lower lung function and worse health-related quality of life (HRQoL) than controlled patients; 197/540 (37%) experienced frequent exacerbations (prior year). Worse St George's Respiratory Questionnaire (SGRQ) total score, comorbid sinusitis, or eczema were significantly associated with uncontrolled SA; younger age, never smoker status, exacerbation requiring hospitalization (previous year), worse SGRQ symptom score, comorbid nasal polyps, COPD, or osteoporosis were significantly associated with uncontrolled SA with frequent exacerbations. CONCLUSIONS In IDEAL, one-fifth of patients with SA were controlled, based on symptoms. Uncontrolled, exacerbating SA was associated with specific comorbidities, frequent exacerbations, a lower lung function, and compromised HRQoL, although inference from this analysis is limited by the selective cross-sectional nature of the cohort. Nonetheless, these data highlight the need for more effective precision treatments in this population.
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Affiliation(s)
- Hana Müllerová
- Real World Evidence, GSK, Stockley Park, Uxbridge, Middlesex, UK
| | - Sarah M Cockle
- Value Evidence and Outcomes, GSK House, Brentford, Middlesex, UK
| | - Necdet B Gunsoy
- Value Evidence and Outcomes, GSK, Stockley Park, Uxbridge, Middlesex, UK
| | | | - Frank C Albers
- Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA
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Przybyszowski M, Stachura T, Szafraniec K, Sladek K, Bochenek G. The influence of self-assessment of asthma control on the Asthma Control Test outcome. J Asthma 2019; 58:537-546. [PMID: 31860372 DOI: 10.1080/02770903.2019.1708098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The Asthma Control Test (ACT) consists of five items, one of which is self-assessment of asthma control. The goal of this study was to compare the responses to the first four ACT items with the response to the fifth item and determine whether this response affects the final ACT score. METHODS Adult asthmatics (n = 417) were recruited from a specialty asthma center in Poland. Clinical data were collected by questionnaire. Spirometry and skin prick tests were performed for clinical evaluation. Asthma control was assessed through the ACT. The cutoff point for uncontrolled asthma was <20 points. RESULTS Asthma was uncontrolled in 42.5% of patients. Based upon scores of the first four ACT items, three clusters of patients were identified. Cluster 1 comprised very well-controlled asthmatics [mean (sd) ACT total score 24.7 (0.7)]. Cluster 2 included both controlled and uncontrolled asthmatics [ACT total score 20.1 (2.5)]. Cluster 3 comprised poorly controlled asthmatics [ACT total score 12.1 (2.9)]. Misjudgment of asthma control in the fifth ACT item had no impact on the ACT total score in clusters 1 and 3. In cluster 2, the response to this item caused misclassification in 10.2% of patients. CONCLUSIONS In patients with either very well or very poorly controlled asthma, the response to the fifth ACT item did not alter the assignment into the appropriate asthma control group. Only in a small group of patients with a total ACT score of approximately 20 points did the asthma group classification result in either controlled or uncontrolled.
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Affiliation(s)
- Marek Przybyszowski
- Faculty of Medicine, Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Stachura
- Faculty of Medicine, Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Krystyna Szafraniec
- Faculty of Health Sciences, Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Krzysztof Sladek
- Faculty of Medicine, Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Grazyna Bochenek
- Faculty of Medicine, Department of Internal Medicine, Jagiellonian University Medical College, Krakow, Poland
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Zhou DD, Ran J, Li CC, Lu J, Zhao QY, Liu XY, Xu YD, Wang Y, Yang YQ, Yin LM. Metallothionein-2 is associated with the amelioration of asthmatic pulmonary function by acupuncture through protein phosphorylation. Biomed Pharmacother 2019; 123:109785. [PMID: 31874444 DOI: 10.1016/j.biopha.2019.109785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/06/2019] [Accepted: 12/08/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Acupuncture has long been used for asthma treatment but the underlying mechanism remains unclear. Previous study showed that metallothionein-2 (MT-2) was significantly decreased in asthmatic lung tissue. However, the relationship between acupuncture treatment and MT-2 expression during asthma is still unknown, and the detailed effect analysis of MT-2 on phosphorylation in airway smooth muscle cells (ASMCs) is also unclear. METHODS The acupuncture effect on pulmonary resistance (RL) was investigated in a rat model of asthma, and the mRNA and protein levels of MT-2 in lung tissue were detected. Primary ASMCs were isolated and treated with MT-2 recombinant protein to study the MT-2 effects on ASMC relaxation. A Phospho Explorer antibody microarray was applied to detect protein phosphorylation changes associated with MT-2-induced ASMC relaxation. Bioinformatic analysis were performed with PANTHER database, DAVID and STRING. Phosphorylation changes in key proteins were confirmed by Western blot. RESULTS Acupuncture significantly reduced RL at 2-5 min (P < 0.05 vs asthma) in asthmatic rats. Acupuncture continued to increase MT-2 mRNA expression in lung tissue for up to 14 days (P < 0.05 vs asthma). The MT-2 protein expression was significantly decreased in the asthmatic rats (P < 0.05 vs control), while MT-2 protein expression was significantly increased in the asthmatic model group treated with acupuncture (P < 0.05 vs asthma). Primary ASMCs were successfully isolated and recombinant MT-2 protein (100, 200, 400 ng/ml) significantly relaxed ASMCs (P < 0.05 vs control). MT-2 induced phosphorylation changes in 51 proteins. Phosphorylation of 14 proteins were upregulated while 37 proteins were downregulated. PANTHER classification revealed eleven functional groups, and the phosphorylated proteins were identified as transferases (27.8 %), calcium-binding proteins (11.1 %), etc. DAVID functional classification showed that the phosphorylated proteins could be attributed to eight functions, including protein phosphorylation and regulation of GTPase activity. STRING protein-protein interaction network analysis showed that Akt1 was one of the most important hubs for the phosphorylated proteins. The phosphorylation changes of Akt1 and CaMK2β were consistent in both the Phospho Explorer antibody microarray and Western blot. CONCLUSION Acupuncture can significantly ameliorate RL, and the MT-2 mRNA and protein levels in lung tissue are increased during treatment. MT-2 significantly relaxes ASMCs and induces a series of protein phosphorylation. These phosphorylation changes, including Akt1 and CaMK2β, may play important roles in the therapeutic effects of acupuncture on asthma.
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Affiliation(s)
- Dong-Dong Zhou
- Laboratory of Molecular Biology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Jun Ran
- Laboratory of Molecular Biology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China; Chongqing Hospital of Traditional Chinese Medicine, Chongqing, 400021, China
| | - Cong-Cong Li
- Laboratory of Molecular Biology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Jin Lu
- Laboratory of Molecular Biology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Qing-Yi Zhao
- Laboratory of Molecular Biology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Xiao-Yan Liu
- Laboratory of Molecular Biology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Yu-Dong Xu
- Laboratory of Molecular Biology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Yu Wang
- Laboratory of Molecular Biology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China
| | - Yong-Qing Yang
- Laboratory of Molecular Biology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China.
| | - Lei-Miao Yin
- Laboratory of Molecular Biology, Shanghai Research Institute of Acupuncture and Meridian, Shanghai University of Traditional Chinese Medicine, Shanghai, 200030, China; Shanghai Innovation Center of Traditional Chinese Medicine Health Service, Shanghai, 201203, China.
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Effect of pranayama breathing technique on asthma control, pulmonary function, and quality of life: A single-blind, randomized, controlled trial. Complement Ther Clin Pract 2019; 38:101081. [PMID: 32056817 DOI: 10.1016/j.ctcp.2019.101081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/06/2019] [Accepted: 12/17/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study evaluated the effect of pranayama on asthma control, pulmonary function, and quality of life in people with asthma. METHODS Pranayama was applied to the pranayama group for 20 min once daily for 1 month, and relaxation was applied to the relaxation group similarly in addition to the standard treatment. The outcome measurement tools used were the Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), pulmonary function test (PFT), and patient observation chart. RESULTS The pranayama group had significantly higher ACT score, overall AQLQ score, and subscale scores than the relaxation group (p < 0.05). However, there was no significant difference between the groups in terms of PFT parameters and peak expiratory flow values (p > 0.05). CONCLUSION Pranayama improved asthma control and asthma-related quality of life in people with asthma, but it did not show a significant difference in PFT values.
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Albataineh E, Al-Zayadneh E, Al-Shagahin H, Al Soloman A, Altarawneh A, Aldmour I. Asthma Control and Its Predictive Factors in Adult Asthma Patients. J Clin Med Res 2019; 11:807-817. [PMID: 31803325 PMCID: PMC6879035 DOI: 10.14740/jocmr4021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/30/2019] [Indexed: 01/27/2023] Open
Abstract
Background Asthma is a highly prevalent condition that remains difficult to control, as its associated factors remain poorly understood. Thus, the primary aim of the present investigation was to determine the prevalence of uncontrolled asthma in hospital units in south Jordan and to evaluate the risk factors that may contribute to uncontrolled asthma. Methods This was a cross-sectional study involving 93 patients aged 40.5 ± 13.6 years that met the criteria of the Global Initiative for Asthma (GINA). Relevant patient data were collected via a questionnaire and through a review of medical records. The questionnaire comprised of sections pertaining to sociodemographic and clinical characteristics, as well as pharmacological asthma treatment, asthma severity and asthma control. Asthma severity was determined in line with the GINA guidelines, whereby the patients were classified into four groups (intermittent, mild persistent, moderate persistent or severe persistent). Moreover, based on the findings yielded by the asthma control questionnaire (ACQ), patients were divided into three levels, whereby those diagnosed with partly controlled and uncontrolled asthma were combined into one group, denoted as "poorly controlled asthma", with "uncontrolled asthma" and "controlled asthma" as the remaining two groups. Atopy was defined as one or more positive reactions (A/H ratio > 1) on a skin prick test. Results Asthma control was achieved in 45.2% of the sample. Moreover, older age, severe asthma according to the GINA guidelines, longer duration of asthma, atopy, being on treatment for asthma and history of allergic rhinitis were identified as the main risk factors contributing to poorly controlled asthma. Multivariate analyses, however, revealed that only atopy to two or more allergens and having severe asthmatic attacks were statistically significantly associated with poorly controlled asthma, for which the odds ratio Mantel-Haenszel (ORMH) of 17.2 and 2.2 was obtained, respectively. Conclusion Our findings indicate that severe asthma and atopy to two or more allergens are the main risk factors for uncontrolled asthma. However, further studies with larger sample sizes are needed to confirm these results.
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Affiliation(s)
- Eman Albataineh
- Department of Microbiology and Immunology, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Enas Al-Zayadneh
- Department of Pediatrics, Faculty of Medicine, Mutah University, Al-Karak, Jordan
| | - Hani Al-Shagahin
- Department of Special Surgery, Faculty of Medicine, Mutah University, Al-Karak, Jordan
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Averell CM, Laliberté F, Duh MS, Wu JW, Germain G, Faison S. Characterizing Real-World Use Of Tiotropium In Asthma In The USA. J Asthma Allergy 2019; 12:309-321. [PMID: 31632091 PMCID: PMC6789414 DOI: 10.2147/jaa.s216932] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/12/2019] [Indexed: 11/23/2022] Open
Abstract
Background Tiotropium bromide (TIO) is a long-acting muscarinic antagonist recommended as an add-on therapy option for patients with uncontrolled asthma on inhaled corticosteroids (ICS) and long-acting β2-agonists (LABA). However, real-world data on TIO use in asthma remains limited. To identify unmet needs, this study explored the use of TIO in US patients with asthma. Methods This retrospective cohort study used IQVIATM Health Plan Claims Data (October 1, 2014─December 31, 2016). Patients with asthma diagnoses initiating TIO 1.25 or 2.5 mcg after September 16, 2015 (first dispensing on index date) with ≥6 and ≥3 months continuous enrollment pre- and post-index, respectively, were identified. Patients with COPD diagnoses were excluded. Baseline characteristics, healthcare resource utilization and costs, and treatment patterns before and following TIO initiation were described for TIO cohorts and subgroups classified by concomitant medications received during the 30-day period after initiation. Results The study included 766 TIO 1.25 mcg and 1055 TIO 2.5 mcg users. In the TIO 1.25 mcg cohort, 16% (126/766) used TIO monotherapy while 61% (465/766) used TIO+ICS/LABA± leukotriene receptor antagonists (triple therapy). In TIO 1.25 mcg monotherapy and triple therapy subgroups, 39% and 49% were treated by allergists/pulmonologists, 27% and 48% experienced a moderate/severe asthma exacerbation, and 50% and 68% used rescue oral corticosteroids during the baseline period, respectively. Following triple therapy initiation, 44% of patients discontinued ICS within 6 months. The TIO 2.5 mcg cohort demonstrated similar trends. Conclusion This study provided insights into real-world US use of TIO in asthma. Overall, 16–19% of patients received TIO monotherapy and had high baseline exacerbation rates, suggesting that additional ICS-containing medication may be beneficial. Patients initiating triple therapy were among the most severe, with high baseline exacerbation rates and rescue medication use, and had high post-treatment ICS discontinuation rates, suggesting unmet needs in this population.
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Affiliation(s)
- Carlyne M Averell
- US Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA
| | | | | | | | | | - Sarai Faison
- US Medical Affairs, GlaxoSmithKline, Research Triangle Park, NC, USA
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Yin LM, Xu YD, Peng LL, Duan TT, Liu JY, Xu Z, Wang WQ, Guan N, Han XJ, Li HY, Pang Y, Wang Y, Chen Z, Zhu W, Deng L, Wu YL, Ge GB, Huang S, Ulloa L, Yang YQ. Transgelin-2 as a therapeutic target for asthmatic pulmonary resistance. Sci Transl Med 2019; 10:10/427/eaam8604. [PMID: 29437149 DOI: 10.1126/scitranslmed.aam8604] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 09/11/2017] [Accepted: 11/01/2017] [Indexed: 12/24/2022]
Abstract
There is a clinical need for new bronchodilator drugs in asthma, because more than half of asthmatic patients do not receive adequate control with current available treatments. We report that inhibition of metallothionein-2 protein expression in lung tissues causes the increase of pulmonary resistance. Conversely, metallothionein-2 protein is more effective than β2-agonists in reducing pulmonary resistance in rodent asthma models, alleviating tension in tracheal spirals, and relaxing airway smooth muscle cells (ASMCs). Metallothionein-2 relaxes ASMCs via transgelin-2 (TG2) and induces dephosphorylation of myosin phosphatase target subunit 1 (MYPT1). We identify TSG12 as a nontoxic, specific TG2-agonist that relaxes ASMCs and reduces asthmatic pulmonary resistance. In vivo, TSG12 reduces pulmonary resistance in both ovalbumin- and house dust mite-induced asthma in mice. TSG12 induces RhoA phosphorylation, thereby inactivating the RhoA-ROCK-MYPT1-MLC pathway and causing ASMCs relaxation. TSG12 is more effective than β2-agonists in relaxing human ASMCs and pulmonary resistance with potential clinical advantages. These results suggest that TSG12 could be a promising therapeutic approach for treating asthma.
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Affiliation(s)
- Lei-Miao Yin
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Yu-Dong Xu
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Ling-Ling Peng
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Ting-Ting Duan
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Jia-Yuan Liu
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Zhijian Xu
- Chinese Academy of Sciences Key Laboratory of Receptor Research, Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Wen-Qian Wang
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Nan Guan
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Xiao-Jie Han
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Hai-Yan Li
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Yu Pang
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Yu Wang
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Zhaoqiang Chen
- Chinese Academy of Sciences Key Laboratory of Receptor Research, Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Weiliang Zhu
- Chinese Academy of Sciences Key Laboratory of Receptor Research, Drug Discovery and Design Center, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Linhong Deng
- Institute of Biomedical Engineering and Health Sciences, Changzhou University, Jiangsu 213164, China
| | - Ying-Li Wu
- Department of Pathophysiology, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Guang-Bo Ge
- Institute of Interdisciplinary Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Shuang Huang
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China.,Department of Biochemistry and Molecular Biology, Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA
| | - Luis Ulloa
- International Laboratory of Neuro-Immunomodulation, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China. .,Center of Immunology and Inflammation, Rutgers New Jersey Medical School, Newark, NJ 07101, USA
| | - Yong-Qing Yang
- Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China.
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Regulation of Airway Smooth Muscle Contraction in Health and Disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1124:381-422. [PMID: 31183836 DOI: 10.1007/978-981-13-5895-1_16] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Airway smooth muscle (ASM) extends from the trachea throughout the bronchial tree to the terminal bronchioles. In utero, spontaneous phasic contraction of fetal ASM is critical for normal lung development by regulating intraluminal fluid movement, ASM differentiation, and release of key growth factors. In contrast, phasic contraction appears to be absent in the adult lung, and regulation of tonic contraction and airflow is under neuronal and humoral control. Accumulating evidence suggests that changes in ASM responsiveness contribute to the pathophysiology of lung diseases with lifelong health impacts.Functional assessments of fetal and adult ASM and airways have defined pharmacological responses and signaling pathways that drive airway contraction and relaxation. Studies using precision-cut lung slices, in which contraction of intrapulmonary airways and ASM calcium signaling can be assessed simultaneously in situ, have been particularly informative. These combined approaches have defined the relative importance of calcium entry into ASM and calcium release from intracellular stores as drivers of spontaneous phasic contraction in utero and excitation-contraction coupling.Increased contractility of ASM in asthma contributes to airway hyperresponsiveness. Studies using animal models and human ASM and airways have characterized inflammatory and other mechanisms underlying increased reactivity to contractile agonists and reduced bronchodilator efficacy of β2-adrenoceptor agonists in severe diseases. Novel bronchodilators and the application of bronchial thermoplasty to ablate increased ASM within asthmatic airways have the potential to overcome limitations of current therapies. These approaches may directly limit excessive airway contraction to improve outcomes for difficult-to-control asthma and other chronic lung diseases.
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Adler KB. Does Transforming Growth Factor-β Induce Persistent Airway Obstruction after Asthma Exacerbations? Am J Respir Cell Mol Biol 2019; 58:543-544. [PMID: 29714630 DOI: 10.1165/rcmb.2017-0339ed] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kenneth B Adler
- 1 College of Veterinary Medicine North Carolina State University Raleigh, North Carolina
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Kabengele BO, Kayembe JMN, Kayembe PK, Kashongue ZM, Kaba DK, Akilimali PZ. Factors associated with uncontrolled asthma in adult asthmatics in Kinshasa, Democratic Republic of Congo. PLoS One 2019; 14:e0215530. [PMID: 30998727 PMCID: PMC6472784 DOI: 10.1371/journal.pone.0215530] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/03/2019] [Indexed: 11/28/2022] Open
Abstract
Background The ultimate goal of asthma treatment is long-term control. Uncontrolled asthma is a major public health problem worldwide, but there is a lack of data on asthma control and its causes in the Democratic Republic of Congo (DRC). Objective To determine the socio-demographic, environmental, clinical, and biological factors and comorbidities associated with uncontrolled adult asthma in Kinshasa, DRC. Methods We performed a cross-sectional study of 216 male and female asthmatics aged 18 and over consecutively recruited from tertiary clinics and the community in Kinshasa between June 2017 and February 2018. For each subject, socio-demographic, clinical, para clinical and environmental data were recorded. Forced Expiratory Volume in one second (FEV1) values were obtained by Spirometry, allergen testing performed using the skin prick test, serum vitamin D levels measured by radioimmunoassay, and asthma control assessed using the asthma control test (ACT) score. Multiple logistic regression identified factors associated with uncontrolled asthma. Results The average age of participants was 45.2 (SD 17.6) years, 74% were female, and 42% had a low educational level. Among all asthmatics, the prevalence of uncontrolled asthma was 56%, abnormal serum vitamin D level 95%, abnormal FEV1 65%, sensitization to two allergens (cat dander and dust mites) 18%, sleep disorders 37%, and heartburn 60%. Male (aOR 2.24; 95% CIs 1.04–4.79), low educational level (aOR 3.26; 95% CIs 1.54–6.67), sensitization to both cat dander and dust mites (aOR 2.67; 95% CIs 1.16–6.14), FEV1 ≤80% (aOR 2.07; 95% CIs 1.08–3.96), abnormal serum vitamin D level (aOR 5.11; 95% CIs 1.17–22.33), sleep disorders (aOR 1.96; 95% CIs 1.04–3.71), and heartburn (aOR 2.02; 95% CIs 1.04–3.92) were significantly associated with uncontrolled asthma. Conclusion Uncontrolled asthma is common in Kinshasa, and these factors associated with uncontrolled asthma may be considered as targets for future intervention strategies.
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Affiliation(s)
- Benoit Obel Kabengele
- Unit of Pneumology, Department of Internal Medicine, University Clinics of Kinshasa, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Jean-Marie Ntumba Kayembe
- Unit of Pneumology, Department of Internal Medicine, University Clinics of Kinshasa, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Patrick Kalambayi Kayembe
- Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Zacharie Munogolo Kashongue
- Unit of Pneumology, Department of Internal Medicine, University Clinics of Kinshasa, Medical School, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Didine Kinkodi Kaba
- Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Pierre Zalagile Akilimali
- Department of Epidemiology and Biostatistics, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Kalaci O, Giangioppo S, Leung G, Radhakrishnan A, Fleischer E, Lyttle B, Price A, Radhakrishnan D. Complementary and alternative medicine use in children with asthma. Complement Ther Clin Pract 2019; 35:272-277. [PMID: 31003669 DOI: 10.1016/j.ctcp.2019.02.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/14/2019] [Accepted: 02/26/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To estimate the overall prevalence of complementary and alternative medicine and specific modalities used among children with asthma, identify predictors of use, and perceived positive or negative effects of therapies. RESULTS Of the 161 children enrolled in the study, 76.4% had ever used complementary and alternative medicine. Humidifiers, air purifiers, and multivitamins were the most common modalities used. Complementary and alternative medicine use in children was associated with family use, younger child age, and disease severity, indicated by recent asthma exacerbation. The majority of participants perceived benefit from their complementary and alternative medicine use, with very few reporting negative side effects. Only 36.7% of participants reported discussing their complementary and alternative medicine use with the asthma clinic healthcare team. CONCLUSIONS The prevalence of complementary and alternative medicine use in children with asthma is high, with the majority of families perceiving benefit from its use. This study offers clinicians a reference to inform families regarding the subjective helpfulness of various types of complementary and alternative medicine modalities that can facilitate the dialogue between health care professionals and families interested in complementary and alternative medicine use.
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Affiliation(s)
- Odion Kalaci
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada.
| | - Sandra Giangioppo
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada.
| | - Garvin Leung
- Faculty of Medicine at the University of Ottawa, Ottawa, ON, K1H 8M5, Canada.
| | - Arun Radhakrishnan
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada.
| | - Erin Fleischer
- Children's Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
| | - Brian Lyttle
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada; Children's Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
| | - April Price
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada; Children's Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
| | - Dhenuka Radhakrishnan
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada; Children's Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, ON, N6A 5W9, Canada.
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Yee MC, Nichols HL, Polley D, Saifeddine M, Pal K, Lee K, Wilson EH, Daines MO, Hollenberg MD, Boitano S, DeFea KA. Protease-activated receptor-2 signaling through β-arrestin-2 mediates Alternaria alkaline serine protease-induced airway inflammation. Am J Physiol Lung Cell Mol Physiol 2018; 315:L1042-L1057. [PMID: 30335499 PMCID: PMC6337008 DOI: 10.1152/ajplung.00196.2018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/06/2018] [Accepted: 08/22/2018] [Indexed: 01/01/2023] Open
Abstract
Alternaria alternata is a fungal allergen associated with severe asthma and asthma exacerbations. Similarly to other asthma-associated allergens, Alternaria secretes a serine-like trypsin protease(s) that is thought to act through the G protein-coupled receptor protease-activated receptor-2 (PAR2) to induce asthma symptoms. However, specific mechanisms underlying Alternaria-induced PAR2 activation and signaling remain ill-defined. We sought to determine whether Alternaria-induced PAR2 signaling contributed to asthma symptoms via a PAR2/β-arrestin signaling axis, identify the protease activity responsible for PAR2 signaling, and determine whether protease activity was sufficient for Alternaria-induced asthma symptoms in animal models. We initially used in vitro models to demonstrate Alternaria-induced PAR2/β-arrestin-2 signaling. Alternaria filtrates were then used to sensitize and challenge wild-type, PAR2-/- and β-arrestin-2-/- mice in vivo. Intranasal administration of Alternaria filtrate resulted in a protease-dependent increase of airway inflammation and mucin production in wild-type but not PAR2-/- or β-arrestin-2-/- mice. Protease was isolated from Alternaria preparations, and select in vitro and in vivo experiments were repeated to evaluate sufficiency of the isolated Alternaria protease to induce asthma phenotype. Administration of a single isolated serine protease from Alternaria, Alternaria alkaline serine protease (AASP), was sufficient to fully activate PAR2 signaling and induce β-arrestin-2-/--dependent eosinophil and lymphocyte recruitment in vivo. In conclusion, Alternaria filtrates induce airway inflammation and mucus hyperplasia largely via AASP using the PAR2/β-arrestin signaling axis. Thus, β-arrestin-biased PAR2 antagonists represent novel therapeutic targets for treating aeroallergen-induced asthma.
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Affiliation(s)
- Michael C Yee
- Biomedical Sciences, Graduate Program, University of California Riverside , Riverside, California
| | - Heddie L Nichols
- Biomedical Sciences, Graduate Program, University of California Riverside , Riverside, California
| | - Danny Polley
- Cumming School of Medicine, Department of Physiology and Pharmacology and Department of Medicine, University of Calgary , Calgary, Alberta , Canada
| | - Mahmoud Saifeddine
- Cumming School of Medicine, Department of Physiology and Pharmacology and Department of Medicine, University of Calgary , Calgary, Alberta , Canada
| | - Kasturi Pal
- Biomedical Sciences, Graduate Program, University of California Riverside , Riverside, California
- Cell Molecular and Developmental Biology and Biochemistry Graduate Program, University of California Riverside , Riverside, California
| | - Kyu Lee
- Biomedical Sciences, Graduate Program, University of California Riverside , Riverside, California
- Molecular Biology Graduate Program, University of California Riverside , Riverside, California
| | - Emma H Wilson
- Biomedical Sciences, Graduate Program, University of California Riverside , Riverside, California
| | - Michael O Daines
- Department of Pediatrics, University of Arizona Health Sciences , Tucson, Arizona
- Asthma and Airway Disease Research Center, University of Arizona Health Sciences , Tucson, Arizona
| | - Morley D Hollenberg
- Cumming School of Medicine, Department of Physiology and Pharmacology and Department of Medicine, University of Calgary , Calgary, Alberta , Canada
| | - Scott Boitano
- Asthma and Airway Disease Research Center, University of Arizona Health Sciences , Tucson, Arizona
- Department of Physiology, University of Arizona Health Sciences , Tucson, Arizona
| | - Kathryn A DeFea
- Biomedical Sciences, Graduate Program, University of California Riverside , Riverside, California
- Cell Molecular and Developmental Biology and Biochemistry Graduate Program, University of California Riverside , Riverside, California
- Molecular Biology Graduate Program, University of California Riverside , Riverside, California
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43
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Leal LF, Bertoldi AD, Menezes AMB, Borges RB, Mengue SS, Gazzana MB, Pizzol TDSD. [Indication, access, and use of medicines for chronic respiratory diseases in Brazil: results from the National Survey on Access, Utilization, and Promotion of Rational Use of Medicines in Brazil (PNAUM), 2014]. CAD SAUDE PUBLICA 2018; 34:e00208217. [PMID: 30329005 DOI: 10.1590/0102-311x00208217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/03/2018] [Indexed: 11/21/2022] Open
Abstract
The study aimed to estimate the prevalence of self-reported chronic respiratory diseases and the indication, access to, and use of medicines, as well as their sources, in the Brazilian adult population. Data were analyzed on adults 20 years and older from the National Survey on Access, Utilization, and Promotion of Rational Use of Medicines in Brazil (PNAUM), conducted from September 2013 to February 2014. Prevalence of chronic respiratory diseases was 3% (95%CI: 2.7-3.3). Of these individuals, 58.1% (95%CI: 51.8-64.0) had an indication for pharmacological treatment. Of those with indication for treatment, 77.1% (95%CI: 71.0-82.8) were using at least one of the prescribed drugs. Total access to therapy was 91.4% (95%CI: 79.9-96.6), and more than half of individuals with chronic respiratory diseases purchased at least one of the drugs in retail pharmacies (57.3%). The most frequently reported drug class was the association of a corticosteroid plus a long-acting beta-2 agonist in inhalation form, the most common example of which was the association budesonide/formoterol (20.3%; 95%CI: 16.0-25.4). According to our study, prevalence of self-reported chronic respiratory diseases was lower than in previous studies published on the Brazilian population. Nearly half of the population reporting chronic respiratory diseases did not have an indication for pharmacological treatment. Among those with such indication, approximately one-fourth were not using medications during the study period, and for those who were on medication, although access was high, they had to pay for their medicines.
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Affiliation(s)
- Lisiane Freitas Leal
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | | | | | - Rogério Boff Borges
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Sotero Serrate Mengue
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Marcelo Basso Gazzana
- Programa de Pós-graduação em Ciências Pneumológicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | - Tatiane da Silva Dal Pizzol
- Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.,Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre Brasil
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Al-Mahrezi A, Baddar S, Al-Siyabi S, Al-Kindi S, Al-Zakwani I, Al-Rawas O. Asthma Clinics in Primary Healthcare Centres in Oman: Do they make a difference? Sultan Qaboos Univ Med J 2018; 18:e137-e142. [PMID: 30210841 DOI: 10.18295/squmj.2018.18.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/07/2018] [Accepted: 03/25/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to determine the effect of newly established asthma clinics (ACs) on asthma management at primary healthcare centres (PHCs) in Oman. Methods This retrospective cross-sectional study was conducted between June 2011 and May 2012 in seven PHCs in the Seeb wilayat of Muscat, Oman. All ≥6-year-old asthmatic patients visiting these PHCs during the study period were included. Electronic medical records were reviewed to determine which clinical assessment and management components had been documented. Results A total of 452 asthmatic patients were included in the study. The mean age was 35 ± 21 years old (range: 6-95 years) and the majority (57%) were female. In total, 288 (64%) cases were managed at ACs and 164 (36%) were managed at general clinics (GCs). Significant differences were noted in the documentation of cases managed at ACs compared to those at GCs, including history-taking information regarding signs and symptoms (91% versus 19%; P <0.001), trigger factors (79% versus 16%; P <0.001) and a history of atopy (81% versus 17%; P <0.001), smoking (61% versus 7%; P <0.001), asthma exacerbations (73% versus 10%; P <0.001) or previous admissions (63% versus 10%; P <0.001). Furthermore, prescription rates of inhaled corticosteroids (72% versus 61%; P = 0.021) and short-acting β-agonists (93% versus 82%; P = 0.001) were significantly higher at ACs compared to GCs. Conclusion Overall, the findings indicated that ACs have had a positive impact on asthma management at the studied PHCs.
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Affiliation(s)
- Abdulaziz Al-Mahrezi
- Department of Family Medicine & Public Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sawsan Baddar
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sheikha Al-Siyabi
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Safaa Al-Kindi
- Directorate General of Primary Health Care, Ministry of Health, Muscat, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Omar Al-Rawas
- Department of Medicine, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
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45
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He LL, Zhang L, Jiang L, Xu F, Fei DS. Efficacy and safety of anti-interleukin-5 therapy in patients with asthma: A pairwise and Bayesian network meta-analysis. Int Immunopharmacol 2018; 64:223-231. [PMID: 30199847 DOI: 10.1016/j.intimp.2018.08.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Anti-interleukin-5 therapy has been proposed as a novel and promising treatment option in asthma treatment. However, the optimum monoclonal antibodies for asthma treatment remain uncertain. METHODS We searched the PubMed, EMBASE and Cochrane databases from their inceptions to June 2018 for randomized controlled trials that reported pulmonary function, adverse events, Asthma Quality of Life Questionnaire (AQLQ) scores, and asthmatic exacerbations resulting from anti-interleukin-5 therapy in asthma patients. Extracted data were analyzed by pairwise and network meta-analysis. RESULTS Twenty-one randomized studies were identified for this analysis. By pairwise meta-analysis using a placebo as the reference, patients treated with monoclonal antibodies were associated with significantly improved forced expiratory volume (FEV1) values (standard mean difference [SMD], 0.18; 95% confidence interval [CI], 0.12-0.23; P < 0.001), lower rates of adverse events (risk ratio [RR], 0.93; 95% CI, 0.90-0.97; P < 0.001) and significant improvements in the AQLQ scores (SMD, 0.20; 95% CI, 0.13-0.26; P < 0.001). There were no significant differences in exacerbations risks (RR, 0.68; 95% CI, 0.11-4.14; P = 0.097). According to network meta-analysis, adverse events-related benefits were seen only with reslizumab, while AQLQ scores benefits, and pulmonary function benefits were still seen with all three monoclonal antibodies. The assessment of rank probabilities indicated that reslizumab presented the greatest likelihood of having benefits for pulmonary function, reducing adverse events and improving AQLQ scores when compared with the placebo, and mepolizumab presented the best benefits for reducing asthmatic exacerbations. CONCLUSIONS Anti-interleukin-5 therapy appears to be a safe and effective treatment for asthma patients with respect to pulmonary lung function, adverse events and AQLQ scores, and do not increase asthmatic exacerbations. Our network meta-analysis in patients with asthma suggests that reducing adverse events benefits due to reslizumab, and pulmonary lung function benefits as well as good AQLQ scores are seen with respect to the three antibodies. Network meta-analysis indicates the probability that the best anti-interlukin-5 therapy for asthma patients might be reslizumab, but further trials are required to determine the most effective asthma treatment drug.
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Affiliation(s)
- Lu-Lu He
- Department of ICU, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lei Zhang
- Department of ICU, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lei Jiang
- Department of ICU, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Feng Xu
- Department of ICU, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Dong-Sheng Fei
- Department of ICU, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
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46
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Huffaker MF, Carchia M, Harris BU, Kethman WC, Murphy TE, Sakarovitch CCD, Qin F, Cornfield DN. Passive Nocturnal Physiologic Monitoring Enables Early Detection of Exacerbations in Children with Asthma. A Proof-of-Concept Study. Am J Respir Crit Care Med 2018; 198:320-328. [PMID: 29688023 PMCID: PMC6835062 DOI: 10.1164/rccm.201712-2606oc] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 04/23/2018] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Asthma management depends on prompt identification of symptoms, which challenges both patients and providers. In asthma, a misapprehension of health between exacerbations can compromise compliance. Thus, there is a need for a tool that permits objective longitudinal monitoring without increasing the burden of patient compliance. OBJECTIVES We sought to determine whether changes in nocturnal physiology are associated with asthma symptoms in pediatric patients. METHODS Using a contactless bed sensor, nocturnal heart rate (HR), respiratory rate, relative stroke volume, and movement in children with asthma 5-18 years of age (n = 16) were recorded. Asthma symptoms and asthma control test (ACT) score were reported every 2 weeks. Random forest model was used to identify physiologic parameters associated with asthma symptoms. Elastic net regression was used to identify variables associated with ACT score. MEASUREMENTS AND MAIN RESULTS The model on the full cohort performed with sensitivity of 47.2%, specificity of 96.3%, and accuracy of 87.4%; HR and respiratory parameters were the most important variables in this model. The model predicted asthma symptoms 35% of the time on the day before perception of symptoms, and 100% of the time for a select subject for which the model performed with greater sensitivity. Multivariable and bivariable analyses demonstrated significant association between HR and respiratory rate parameters and ACT score. CONCLUSIONS Nocturnal physiologic changes correlate with asthma symptoms, supporting the notion that nocturnal physiologic monitoring represents an objective diagnostic tool capable of longitudinally assessing disease control and predicting asthma exacerbations in children with asthma at home.
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Affiliation(s)
| | | | - Bronwyn U. Harris
- Department of Pediatrics–Cardiology
- Tueo Health, Inc., San Francisco, California
| | | | | | | | | | - David N. Cornfield
- Center for Excellence in Pulmonary Biology, Division of Pulmonary, Asthma, and Sleep Medicine, Department of Pediatrics, Stanford University Medical School, Stanford, California; and
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Andrianasolo RM, Kesse-Guyot E, Adjibade M, Hercberg S, Galan P, Varraso R. Associations between dietary scores with asthma symptoms and asthma control in adults. Eur Respir J 2018; 52:13993003.02572-2017. [PMID: 29997182 DOI: 10.1183/13993003.02572-2017] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/09/2018] [Indexed: 11/05/2022]
Abstract
Associations between asthma and the nutritional quality of diet remain poorly understood. We investigated the associations between overall quality of diet evaluated by three dietary scores (the Alternate Healthy Eating Index 2010 (AHEI-2010), the literature-based adherence score to Mediterranean diet (MEDI-LITE) and the modified Programme National Nutrition Santé Guideline Score (mPNNS-GS)) and the asthma symptom score and asthma control.In 2017, 34 766 participants from the NutriNet-Santé cohort answered a detailed respiratory questionnaire. Asthma was defined by the asthma symptom score (as the sum of five questions) and asthma control by the asthma control test (ACT).Roughly 25% of participants reported at least one asthma symptom and for the three dietary scores we observed a statistically significant negative association between a healthier diet and the asthma symptom score (for AHEI-2010, the adjusted OR was 0.79 (95% CI 0.75-0.84) for women and 0.67 (95% CI 0.60-0.75) for men). Among participants with asthma (n=2609) we also observed a negative association between a healthier diet and poorly controlled asthma. This was significant in men (OR 0.39 (95% CI 0.18-0.84) for the AHEI-2010) and borderline significant in women (OR 0.73 (95% CI 0.53-1.01) for the AHEI-2010; p=0.06 for trend).Healthier diet behaviours were associated with fewer asthma symptoms and greater asthma control.
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Affiliation(s)
- Roland M Andrianasolo
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Bobigny, France
| | - Emmanuelle Kesse-Guyot
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Bobigny, France
| | - Moufidath Adjibade
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Bobigny, France
| | - Serge Hercberg
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Bobigny, France.,Département de Santé Publique, Hôpital Avicenne, Bobigny, France
| | - Pilar Galan
- Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Bobigny, France
| | - Raphaëlle Varraso
- Inserm, U1168, VIMA: Aging and chronic diseases. Epidemiological and public health approaches, Villejuif, France.,Uniiversité Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
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48
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Forte GC, Hennemann ML, Dalcin PDTR. Asthma control, lung function, nutritional status, and health-related quality of life: differences between adult males and females with asthma. J Bras Pneumol 2018; 44:273-278. [PMID: 29947717 PMCID: PMC6326714 DOI: 10.1590/s1806-37562017000000216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/30/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate health-related quality of life in asthma patients treated at a referral center in southern Brazil, identifying differences between male and female patients, as well as to evaluate differences between the males and females in terms of asthma control, lung function, and nutritional status. METHODS This was a cross-sectional study involving patients ≥ 18 years of age treated at an asthma outpatient clinic. We evaluated clinical parameters, lung function, nutritional status, and quality of life. RESULTS A total of 198 patients completed the study. The mean age was 56.2 ± 14.8 years, and 81.8% were female. The proportion of patients with uncontrolled asthma was higher among females than among males (63.0% vs. 44.4%; p = 0.041). The body mass index (BMI) and percentage of body fat were higher in females than in males (30.2 ± 5.8 kg/m2 vs. 26.9 ± 4.5 kg/m2 and 37.4 ± 6.4% vs. 26.5 ± 7.4%; p = 0.002 and p < 0.001, respectively). Quality of life was lower in females than in males in the following domains: symptoms (3.8 ± 1.5 vs. 4.6 ± 1.7; p = 0.006); activity limitation (3.6 ± 1.3 vs. 4.4 ± 1.5; p = 0.001); emotional function (3.6 ± 1.9 vs. 4.5 ± 1.7; p = 0.014); and environmental stimuli (3.2 ± 1.6 vs. 4.3 ± 1.9; p = 0.001). CONCLUSIONS Male asthma patients appear to fare better than do female asthma patients in terms of health-related quality of life, asthma control, BMI, percentage of body fat, and comorbidities.
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Affiliation(s)
- Gabriele Carra Forte
- . Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Maria Luiza Hennemann
- . Departamento de Nutrição, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
| | - Paulo de Tarso Roth Dalcin
- . Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS) Brasil
- . Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre (RS) Brasil
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Serra MF, Cotias AC, Pão CRR, Daleprane JB, Jurgilas PB, Couto GC, Anjos-Valotta EA, Cordeiro RSB, Carvalho VF, Silva PMR, Martins MA. Repeated Allergen Exposure in A/J Mice Causes Steroid-Insensitive Asthma via a Defect in Glucocorticoid Receptor Bioavailability. THE JOURNAL OF IMMUNOLOGY 2018; 201:851-860. [PMID: 29914889 DOI: 10.4049/jimmunol.1700933] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 05/23/2018] [Indexed: 12/21/2022]
Abstract
The importance of developing new animal models to assess the pathogenesis of glucocorticoid (GC)-insensitive asthma has been stressed. Because of the asthma-prone background of A/J mice, we hypothesized that asthma changes in these animals would be or become resistant to GCs under repeated exposures to an allergen. A/J mice were challenged with OVA for 2 or 4 consecutive d, starting on day 19 postsensitization. Oral dexamethasone or inhaled budesonide were given 1 h before challenge, and analyses were done 24 h after the last challenge. Airway hyperreactivity, leukocyte infiltration, tissue remodeling, and cytokine levels as well as phosphorylated GC receptor (p-GCR), p-GATA-3, p-p38, MAPK phosphatase-1 (MKP-1), and GC-induced leucine zipper (GILZ) levels were assessed. A/J mice subjected to two daily consecutive challenges reacted with airway hyperreactivity, subepithelial fibrosis, and marked accumulation of eosinophils in both bronchoalveolar lavage fluid and peribronchial space, all of which were clearly sensitive to dexamethasone and budesonide. Conversely, under four provocations, most of these changes were steroid resistant. A significant reduction in p-GCR/GCR ratio following 4- but not 2-d treatment was observed, as compared with untreated positive control. Accordingly, steroid efficacy to transactivate MKP-1 and GILZ and to downregulate p-p38, p-GATA-3 as well as proinflammatory cytokine levels was also seen after two but not four provocations. In conclusion, we report that repeated allergen exposure causes GC-insensitive asthma in A/J mice in a mechanism associated with decrease in GCR availability and subsequent loss of steroid capacity to modulate pivotal regulatory proteins, such as GATA-3, p-p38, MKP-1, and GILZ.
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Affiliation(s)
- Magda F Serra
- Laboratory of Inflammation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ 21040-900 Brazil; and
| | - Amanda C Cotias
- Laboratory of Inflammation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ 21040-900 Brazil; and
| | - Camila R R Pão
- Laboratory of Inflammation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ 21040-900 Brazil; and
| | - Julio B Daleprane
- Basic and Experimental Nutrition, State University of Rio de Janeiro, Rio de Janeiro, RJ 20550-900 Brazil
| | - Patricia B Jurgilas
- Laboratory of Inflammation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ 21040-900 Brazil; and
| | - Gina C Couto
- Laboratory of Inflammation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ 21040-900 Brazil; and
| | - Edna A Anjos-Valotta
- Laboratory of Inflammation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ 21040-900 Brazil; and
| | - Renato S B Cordeiro
- Laboratory of Inflammation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ 21040-900 Brazil; and
| | - Vinicius F Carvalho
- Laboratory of Inflammation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ 21040-900 Brazil; and
| | - Patricia M R Silva
- Laboratory of Inflammation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ 21040-900 Brazil; and
| | - Marco A Martins
- Laboratory of Inflammation, Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, RJ 21040-900 Brazil; and
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50
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Ilmarinen P, Tuomisto LE, Niemelä O, Kankaanranta H. Prevalence of Patients Eligible for Anti-IL-5 Treatment in a Cohort of Adult-Onset Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 7:165-174.e4. [PMID: 29894793 DOI: 10.1016/j.jaip.2018.05.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Antibodies against the IL-5 pathway have been developed for the treatment of late-onset eosinophilic corticosteroid-resistant asthma. However, the prevalence of severe asthma and the proportion of patients who could benefit from such treatment among the general population of asthmatics remain unknown. OBJECTIVE To evaluate the prevalence and characteristics of patients eligible to anti-IL-5 treatment and severe asthma in an unselected cohort of adult-onset asthma. METHODS Seinäjoki Adult Asthma Study is a 12-year follow-up study of patients with new-onset adult asthma (n = 203). Prevalence was estimated based on information collected at 12-year follow-up visit. Health care use was collected from the whole 12-year follow-up period. RESULTS The prevalence of anti-IL-5-treatable patients was 2%, when the following criteria were used: daily use of medium-to-high inhaled corticosteroid (ICS) dose and long-acting β2-agonist, ≥2 exacerbations/previous year and blood eosinophil count ≥300 cells/μL or fraction of exhaled nitric oxide ≥ 50 ppb. The prevalence of severe asthma, as defined according to European Respiratory Society/American Thoracic Society, was 5.9%, and only 1 patient met criteria for both groups. When compared with anti-IL-5 eligible patients, severe asthmatics were more often current smokers at diagnosis, obese, used higher ICS dose, and had higher blood neutrophils 12 years after diagnosis. Both groups differed from nonsevere asthma by a higher number of all and unplanned respiratory-related visits to health care. Severe asthmatics showed the highest number of hospitalizations. CONCLUSIONS In a cohort of unselected consecutive patients with adult-onset asthma, 5.9% fulfilled criteria for severe asthma and 2% qualified for anti-IL-5 treatment. Both groups represent a high burden to health care and specifically targeted treatment could lead to lower use of health care at long term.
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Affiliation(s)
- Pinja Ilmarinen
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
| | - Leena E Tuomisto
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Onni Niemelä
- Department of Laboratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland; Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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