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Zhan W, Wu F, Zhang Y, Lin L, Li W, Luo W, Yi F, Dai Y, Li S, Lin J, Yuan Y, Qiu C, Jiang Y, Zhao L, Chen M, Qiu Z, Chen R, Xie J, Guo C, Jiang M, Yang X, Shi G, Sun D, Chen R, Zhong N, Shen H, Lai K. Identification of cough-variant asthma phenotypes based on clinical and pathophysiologic data. J Allergy Clin Immunol 2023; 152:622-632. [PMID: 37178731 DOI: 10.1016/j.jaci.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Cough-variant asthma (CVA) may respond differently to antiasthmatic treatment. There are limited data on the heterogeneity of CVA. OBJECTIVE We aimed to classify patients with CVA using cluster analysis based on clinicophysiologic parameters and to unveil the underlying molecular pathways of these phenotypes with transcriptomic data of sputum cells. METHODS We applied k-mean clustering to 342 newly physician-diagnosed patients with CVA from a prospective multicenter observational cohort using 10 prespecified baseline clinical and pathophysiologic variables. The clusters were compared according to clinical features, treatment response, and sputum transcriptomic data. RESULTS Three stable CVA clusters were identified. Cluster 1 (n = 176) was characterized by female predominance, late onset, normal lung function, and a low proportion of complete resolution of cough (60.8%) after antiasthmatic treatment. Patients in cluster 2 (n = 105) presented with young, nocturnal cough, atopy, high type 2 inflammation, and a high proportion of complete resolution of cough (73.3%) with a highly upregulated coexpression gene network that related to type 2 immunity. Patients in cluster 3 (n = 61) had high body mass index, long disease duration, family history of asthma, low lung function, and low proportion of complete resolution of cough (54.1%). TH17 immunity and type 2 immunity coexpression gene networks were both upregulated in clusters 1 and 3. CONCLUSION Three clusters of CVA were identified with different clinical, pathophysiologic, and transcriptomic features and responses to antiasthmatics treatment, which may improve our understanding of pathogenesis and help clinicians develop individualized cough treatment in asthma.
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Affiliation(s)
- Wenzhi Zhan
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feng Wu
- Department of Pulmonary and Critical Care Medicine, Huizhou the Third People's Hospital, Guangzhou Medical University, Huizhou, China
| | - Yunhui Zhang
- Department of Pulmonary and Critical Care Medicine, the First People's Hospital of Yunnan Province, Kunming, China
| | - Lin Lin
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, the Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen Li
- Department of Pulmonary and Critical Care Medicine, Key Laboratory of Respiratory Disease of Zhejiang Province, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wei Luo
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Fang Yi
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuanrong Dai
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Suyun Li
- Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiangtao Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yadong Yuan
- Department of Pulmonary and Critical Care Medicine, the Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chen Qiu
- Department of Respiratory and Critical Care Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, the First Affiliated Hospital of Southern University of Science and Technology, the Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Yong Jiang
- Department of Respiratory and Critical Care Medicine, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Limin Zhao
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Meihua Chen
- Department of Pulmonary and Critical Care Medicine, Songshan Lake Central Hospital of Dongguan City, the Third People's Hospital of Dongguan City, Dongguan, China
| | - Zhongmin Qiu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruchong Chen
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaxing Xie
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunxing Guo
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mei Jiang
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaohong Yang
- Department of Respiratory and Critical Care Medicine, Xinjiang Interstitial Lung Disease Clinical Medicine Research Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Guochao Shi
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dejun Sun
- Department of Pulmonary and Critical Care Medicine, the Inner Mongolia Autonomous Region People's Hospital, Hohhot, China
| | - Rongchang Chen
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; Department of Respiratory and Critical Care Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, the First Affiliated Hospital of Southern University of Science and Technology, the Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Nanshan Zhong
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huahao Shen
- Department of Pulmonary and Critical Care Medicine, Key Laboratory of Respiratory Disease of Zhejiang Province, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Kefang Lai
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
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Jiang H, Bai Z, Ou Y, Liu H, Si Z, Liu Y, Liu X, Liu X, Zhang Z, Tan N. β-Hydroxybutyric acid upregulated by Suhuang antitussive capsule ameliorates cough variant asthma through GSK3β/AMPK-Nrf2 signal axis. JOURNAL OF ETHNOPHARMACOLOGY 2023; 307:116013. [PMID: 36586526 DOI: 10.1016/j.jep.2022.116013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/18/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Cough variant asthma (CVA) is a chronic inflammatory disease characterized by cough as the main symptom. Suhuang antitussive capsule (Suhuang), one of traditional Chinese patent medicines, mainly treats CVA clinically. Previous studies have shown that Suhuang significantly improved CVA, post-infectious cough (PIC), sputum obstruction and airway remodeling. However, the effect of Suhuang on ovalbumin-induced (OVA-induced) metabolic abnormalities in CVA is unknown. AIM OF THE STUDY This study aimed to identify potential metabolites associated with efficacy of Suhuang in the treatment of CVA, and determined how Suhuang regulates metabolites, and differential metabolites reduce inflammation and oxidative stress. MATERIALS AND METHODS Rats were given 1 mg OVA/100 mg aluminum hydroxide in the 1st and 7th days by intraperitoneal injection and challenged by atomizing inhalation of 1% OVA saline solution after two weeks to establish the CVA model. Rats were intragastrically (i.g.) administrated with Suhuang at 1.4 g/kg and β-hydroxybutyric acid (β-HB) were given with different concentrations (87.5 and 175 mg/kg/day) by intraperitoneal injection for 2 weeks. After 26 days, GC-MS-based metabolomic approach was applied to observe metabolic changes and search differential metabolites. The number of coughs, coughs latencies, enzyme-linked immunosorbent assay (ELISA), histological analysis and quantitative-polymerase chain reaction (Q-PCR) were used to investigate the effects of Suhuang. Then β-HB on CVA rats, NLRP3 inflammasome and GSK3β/AMPK/Nrf2 signalling pathway were detected by western blotting. RESULTS The results showed that Suhuang treatment significantly enhanced the serum level of β-HB. Interestingly, exposure to exogenous β-HB was also protective against OVA-induced CVA. β-HB significantly reduced the number of coughs and lengthened coughs latencies, improved lung injury, reduced the secretion of various cytokines, and directly inhibited the NLRP3 inflammasome. In addition, β-HB increased the nuclear accumulation of Nrf2 by activating the GSK3β/AMPK signaling axis, and then inactivating the NF-κB signaling pathway, effectively protecting OVA-induced CVA from oxidative stress and inflammation. CONCLUSIONS The results of this study shows that β-HB can reduce inflammation and oxidative stress, the increased production of β-HB in serum might be the crucial factor for Suhuang to exert its effect in the treatment of CVA.
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Affiliation(s)
- Hong Jiang
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Ziyu Bai
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Yongyu Ou
- Beijing Haiyan Pharmaceutical Co., Ltd., Yangtze River Pharmaceutical Group, Beijing, 102206, PR China
| | - Huiling Liu
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Zilin Si
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Yafang Liu
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Xiaoqiong Liu
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Xiaoqing Liu
- Beijing Haiyan Pharmaceutical Co., Ltd., Yangtze River Pharmaceutical Group, Beijing, 102206, PR China.
| | - Zhihao Zhang
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China.
| | - Ninghua Tan
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China.
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Suhuang Antitussive Capsule Ameliorates Corticosteroid Insensitivity in Cough Variant Asthma Guinea Pigs by Inhibiting p38 MAPK Signal Pathway. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1699429. [PMID: 35341157 PMCID: PMC8947934 DOI: 10.1155/2022/1699429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 01/25/2022] [Accepted: 02/22/2022] [Indexed: 11/28/2022]
Abstract
Methods The CVA guinea pig model was successfully established by use of ovalbumin (OVA) sensitization and cigarette smoke (CS) exposure. The guinea pigs were divided into 6 groups: a control group, an OVA model group, an OVA + CS model group, a Suhuang treatment group, a BUD treatment group, and a combination (Suhuang and BUD) treatment group. The effects of the treatment were determined by measuring lung function (RI/Cydn) and cough symptoms (coughs number/cough latency) as outcome criteria. The levels of inflammatory cytokines in bronchoalveolar lavage fluid (BALF) were determined by ELISA. Lung tissues were stained by hematoxylin and eosin (H&E). The expressions of GR/total p38 MAPK/p-p38 MAPK were detected by Western blot. The MKP-1 mRNA levels were detected by RT-PCR. Results Combination treatment significantly decreased RI/coughs numbers and increased Cydn/cough latency. Significantly, the results indicated that combination treatment decreased injury to pulmonary tissues. Results also revealed that levels of inflammatory cytokines were reduced in all treatment groups but most markedly in the combination treatment group. Moreover, Suhuang treatment significantly ameliorated corticosteroid insensitivity by improving the expression of glucocorticoid receptors (GR). The expressions of total p38 MAPK and p-p38 MAPK in lung tissue were significantly inhibited in the Suhuang and combination treatment groups. The MKP-1 mRNA levels in Suhuang and combination treatment groups were also increased significantly. Conclusion Suhuang was effective for reversing corticosteroid insensitivity by regulating the p38 MAPK signal pathway, and combining BUD and Suhuang treatment showed synergistic interactions in CVA guinea pigs. Our findings showed that this combination therapy might be a promising therapeutic agent for CVA and also clarified its underlying mechanism of action, providing a theoretical basis for clinical combination treatment with Suhuang and BUD in CVA patients.
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Lai K, Zhan W, Wu F, Zhang Y, Lin L, Li W, Yi F, Jiang Z, Dai Y, Li S, Lin J, Yuan Y, Jiang Y, Qiu C, Zhao L, Chen M, Qiu Z, Li H, Chen R, Luo W, Xie J, Guo C, Jiang M, Yang X, Shi G, Sun D, Chen R, Chung KF, Shen H, Zhong N. Clinical and Inflammatory Characteristics of the Chinese APAC Cough Variant Asthma Cohort. Front Med (Lausanne) 2022; 8:807385. [PMID: 35127763 PMCID: PMC8814600 DOI: 10.3389/fmed.2021.807385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/13/2021] [Indexed: 12/15/2022] Open
Abstract
Background The AtyPical Asthma in China (APAC) cohort is a multi-center prospective, observational cohort set-up to investigate the clinical, pathophysiological features, prognosis, and mechanisms of cough variant asthma (CVA). Objectives To present the characteristics of newly physician-diagnosed adults with CVA (n = 328) compared to mild-moderate classic asthma (CA, n = 206). Methods and Main Results CVA subjects showed a higher proportion of female (67.1 vs. 55.3%, P = 0.0084), abnormal laryngopharyngeal sensations (71 vs. 51%, p < 0.0001) than CA, but presented with near normal spirometry and higher methacholine PD20-FEV1 values [4.2 (1, 8.6) vs. 0.8 (0.4, 4.7), P < 0.0001]. Lower fractional exhaled nitric oxide (FENO) levels [38.5 (19.8, 72.5) vs. 53. (28.5, 92.2), P = 0.0019], blood eosinophil counts [0.2 (0.1, 0.4) vs. 0.3 (0.2, 0.5), P = 0.0014], and sputum eosinophils [2.3 (0.3, 8.0) vs. 12.2 (2, 34.5), p < 0.0001] were found in CVA. Despite lower total serum IgE levels in CVA, there was similar proportion of atopy in both groups. The prevalence of cough in CA was 86.4%, while CVA reported more severe cough on Visual Analog Scale, Cough Evaluation Test, and Leicester Cough Questionnaire, similar anxiety and depression scores but better asthma control scores as reflected by Asthma Control Test compared to CA. No correlation was found between cough assessment outcomes and sputum eosinophil count, blood eosinophil count, FENO, spirometry variables, or PD20-FEV1. Conclusion Cough variant asthma is distinctive from classic asthma in regard to clinical features, lung function, and airway inflammation. Quality of life is badly impaired as well in spite of better asthma control scores.
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Affiliation(s)
- Kefang Lai
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenzhi Zhan
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feng Wu
- Department of Pulmonary and Critical Care Medicine, Huizhou The Third People's Hospital, Huizhou, China
| | - Yunhui Zhang
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yunnan Province, Kunming, China
| | - Lin Lin
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Academy of Chinese Medical Sciences, The Second Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen Li
- Department of Pulmonary and Critical Care Medicine, Key Laboratory of Respiratory Disease of Zhejiang Province, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Fang Yi
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ziyu Jiang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuanrong Dai
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Suyun Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiangtao Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yadong Yuan
- Department of Pulmonary and Critical Care Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yong Jiang
- Department of Respiratory and Critical Care Medicine, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine, Shenzhen, China
| | - Chen Qiu
- Department of Respiratory and Critical Care Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Limin Zhao
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Meihua Chen
- Department of Pulmonary and Critical Care Medicine, Songshan Lake Central Hospital of Dongguan City, The Third People's Hospital of Dongguan City, Dongguan, China
| | - Zhongmin Qiu
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Tongji Hospital, Tongji University, Shanghai, China
| | - Hu Li
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ruchong Chen
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Luo
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaxing Xie
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunxing Guo
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mei Jiang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaohong Yang
- Department of Respiratory and Critical Care Medicine, Xinjiang Interstitial Lung Disease Clinical Medicine Research Center, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Guochao Shi
- Department of Pulmonary and Critical Care Medicine, School of Medicine, Ruijin Hospital, Shanghai Jiao Tong University, Beijing, China
| | - Dejun Sun
- Department of Pulmonary and Critical Care Medicine, The Inner Mongolia Autonomous Region People's Hospital, Hohhot, China
| | - Rongchang Chen
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Respiratory and Critical Care Medicine, Shenzhen Institute of Respiratory Diseases, Shenzhen People's Hospital, The First Affiliated Hospital of Southern University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Kian Fan Chung
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Foundation NHS Trust, London, United Kingdom
| | - Huahao Shen
- Department of Pulmonary and Critical Care Medicine, Key Laboratory of Respiratory Disease of Zhejiang Province, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Nanshan Zhong
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Huang H, Hua W, Chen R, Hu Y, Ying S, Chi C, Zhang M, Huang K, Liu H, Shen H, Lai K. Perspectives and Management of Atypical Asthma in Chinese Specialists and Primary Care Practitioners-A Nationwide Questionnaire Survey. Front Med (Lausanne) 2021; 8:727381. [PMID: 34778289 PMCID: PMC8582351 DOI: 10.3389/fmed.2021.727381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background and objective: To evaluate the awareness/knowledge and clinical practice for the treatment of atypical asthma among respiratory specialists and primary care practitioners (PCPs) in China. Methods: A total number of 1,997 physicians participated in the survey via WeChat. The questionnaire included six main items: physician demographic characteristics, awareness, diagnosis, medical prescription, assessment/education, and proposal. Results: Cough variant asthma (CVA) was recognized by 97.51% of physicians (1,166 respiratory specialists and 799 PCPs), followed by chest tightness variant asthma (CTVA, 83.72%) and occult asthma (73.54%). Specialists were more likely to follow diagnostic recommendations than PCPs (P < 0.01); however, 34.15% of physicians reported the utility of bronchodilation tests, airway provocation tests, and peak expiratory flow monitoring. A total of 91.70% and 92.01% of physicians prescribed inhaled corticosteroids (ICS) or ICS plus long-acting beta-agonists (LABA) for CVA and CTVA, respectively. Physicians prescribed an ICS or ICS/LABA for 4 (2–8) or 8 (4–12) weeks for CVA and 4 (2–8) or 5 (4–12) weeks for CTVA, and the prescription durations were significantly shorter for PCPs than for specialists (P < 0.01). Further, 52.42% and 35.78% reported good control of CVA and CTVA, respectively, with significantly lower control rates for PCPs than for specialists (P < 0.01). Additionally, specialists exhibited better assessment and educational habits than PCPs. Conclusion: While atypical asthma was identified by most specialists and PCPs, there remains a gap between management in real clinical practice and guideline recommendations, especially for PCPs. Further training of PCPs and clinical studies of atypical asthma are required to improve practice.
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Affiliation(s)
- Huaqiong Huang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Hua
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Ruchong Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yue Hu
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Songmin Ying
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Chunhua Chi
- Department of General Practice, Peking University First Hospital, Beijing, China
| | - Min Zhang
- Department of Respiratory and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kewu Huang
- Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Huiguo Liu
- Key Laboratory of Pulmonary Diseases of Health Ministry, Department of Respiratory and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huahao Shen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Kefang Lai
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Hurtado-Ruzza R, Iglesias ÓÁC, Dacal-Quintas R, Becerro-de-Bengoa-Vallejo R, Calvo-Lobo C, San-Antolín M, Losa-Iglesias ME, López-López D. Asthma, much more than a respiratory disease: influence of depression and anxiety. ACTA ACUST UNITED AC 2021; 67:571-576. [PMID: 34495063 DOI: 10.1590/1806-9282.20201066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/24/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The goals of this study are to compare self-reported depression and anxiety in subjects diagnosed of asthma and healthy controls. METHODS We designed a case-control study. Subjects were recruited using a consecutive sampling method from a single institution. Two groups were created: Asthma and healthy controls. Data of medical history and demographic background were collected from the medical record. Self-reported depression level was assessed using Beck's depression inventory (BDI). Self-reported anxiety was measured with the "State-trait anxiety inventory" (STAI). RESULTS Fifty-one subjects with asthma, and fifty healthy patients were included in this study. BDI scores (p<0.001) were higher for asthma (10.22±7.3) than in the control group (5.2±6.56). STAI state (p<0.001) was higher in asthma (42.61±11.5) than in controls (34.88±9.25). STAI trait (p<0.001) showed higher scores in asthma (43.14±10.89) than in controls (34.62±9.19). CONCLUSIONS These study findings showed that BDI, and STAI trait and state scores are significantly higher in subjects who suffer from asthma than healthy controls.
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Affiliation(s)
- Rafael Hurtado-Ruzza
- Universidade da Coruña, Research, Faculty of Nursing and Podiatry, Health and Podiatry Group, Department of Health Sciences - Ferrol, Spain.,Complexo Hospitalario Universitario de Ourense - Ourense, Spain
| | - Óscar Álvarez-Calderón Iglesias
- Universidade da Coruña, Research, Faculty of Nursing and Podiatry, Health and Podiatry Group, Department of Health Sciences - Ferrol, Spain.,Complexo Hospitalario Universitario de Ourense - Ourense, Spain
| | - Raquel Dacal-Quintas
- Complexo Hospitalario Universitario de Ourense, Pneumology Department - Ourense, Spain
| | | | - César Calvo-Lobo
- Universidad Complutense de Madrid, Faculty of Nursing, Physiotherapy, and Podology - Madri, Spain
| | - Marta San-Antolín
- Universidad Europea de Madrid, Department of Psychology - Madrid, Spain
| | | | - Daniel López-López
- Universidade da Coruña, Research, Faculty of Nursing and Podiatry, Health and Podiatry Group, Department of Health Sciences - Ferrol, Spain
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7
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Zhou G, Zeng Q, Wei W, Teng H, Liu C, Zhou Z, Liang B, Long H. A pilot study of differential gene expressions in patients with cough variant asthma and classic bronchial asthma. J Asthma 2021; 59:1070-1078. [PMID: 33878997 DOI: 10.1080/02770903.2021.1917604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Despite extensive exploration of asthma, the mechanism of asthma has not been fully elucidated. Cough variant asthma (CVA) is considered as precursor to classical asthma (CA). Comparative study between CA and CVA may be helpful in further understanding the pathogenesis of asthma. METHODS Peripheral blood mononuclear cells (PBMCs) were isolated from CVA, CA and healthy adults. Each group consisted of five cases. Total RNA was extracted from the PBMCs. Agilent 4 × 44 K human genome oligo microarray was used to detect whole genome expression. Allogeneic clustering, Gene Ontology and KEGG analysis were performed to investigate differentially expressed genes (DEGs). Then, ten candidate genes were screened and verified by real-time PCR. RESULTS Gene expressions were significantly different among the three groups, with 202 DEGs between the CA and the CVA groups. The Gene Ontology analysis suggested that the DEGs were significantly enriched in 'histone H4-K20 demethylation' and 'antigen processing and presentation of endogenous antigens'. HDC, EGR1, DEFA4, LTF, G0S2, IL4, TFF3, CTSG, FCER1A and CAMP were selected as candidate genes. However, the results of real-time PCR showed that the expression levels of FCER1A, IL4 and HDC in the cough variant asthma group were significantly different from those in the other two groups (p < 0.05). CONCLUSIONS The pathogenesis of CVA and CA may be related to genes such as FCER1A, HDC and IL4. Further studies incorporating a larger sample size should be conducted to find more candidate genes and mechanisms.
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Affiliation(s)
- Guanghong Zhou
- Department of Respiratory and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, P. R. China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, P. R. China.,North Sichuan Medical College, Nanchong, Sichuan, P. R. China
| | - Qingcui Zeng
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, P. R. China.,Department of Geriatric intensive care unit, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, P. R. China
| | - Wei Wei
- Department of Geriatric intensive care unit, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, P. R. China.,Department of Respiratory and Critical Care Medicine, Anyue County People's Hospital, Anyue, Sichuan, P. R. China
| | - Hong Teng
- Department of Respiratory and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, P. R. China
| | - Chuntao Liu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Zhongwei Zhou
- Department of Respiratory and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, P. R. China
| | - Binmiao Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Huaicong Long
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, P. R. China.,Department of Geriatric intensive care unit, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, P. R. China
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8
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de Albornoz SC, Chen G. Relationship between health-related quality of life and subjective wellbeing in asthma. J Psychosom Res 2021; 142:110356. [PMID: 33454566 DOI: 10.1016/j.jpsychores.2021.110356] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 12/17/2020] [Accepted: 01/02/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Poor health-related quality of life (HRQoL) is associated with a high risk of acute exacerbations in patients with asthma. The use of health state utility instruments to measure HRQoL is common, but it has been criticised for failing to adequately capture the impact of the condition from the patient perspective. We aimed to assess the ability of subjective wellbeing and health state utility instruments to capture important HRQoL dimensions for asthma patients. METHODS Regression analyses were conducted using data (n = 856 asthma patients) from a large multi-national cross-sectional survey to explore the relationship between subjective wellbeing (ONS4, PWI, SWLS), health state utility (15D, AQoL-8D, EQ-5D-5L, HUI3, SF-6D, SF-6Dv2), and an asthma-specific instrument (AQLQ-S). The latent structure of different instruments was investigated using an exploratory factor analysis. RESULTS All instruments could distinguish the impact of asthma on HRQoL. Among health utility instruments, 15D, SF-6D and AQoL-8D were more sensitive based on the average standardised regression coefficients. AQOL-8D had the strongest correlation with subjective wellbeing. Nevertheless, the exploratory factor analysis showed a complementary relationship between subjective wellbeing and HRQoL instruments. The most important subjective wellbeing domains were standard of living, achieving in life, and personal relationships; although contributions of these domains to overall life satisfaction differed among asthma patients identified by a latent class analysis. CONCLUSION The use of subjective wellbeing alongside AQLQ-S and health state utility instruments provides a comprehensive approach to assess the impact of asthma on the patient's life. Further research is needed to incorporate these measures in health care evaluation.
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Affiliation(s)
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, Australia.
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9
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Javelot H, Weiner L. Panic and pandemic: Narrative review of the literature on the links and risks of panic disorder as a consequence of the SARS-CoV-2 pandemic. L'ENCEPHALE 2021; 47:38-42. [PMID: 33221039 PMCID: PMC7416744 DOI: 10.1016/j.encep.2020.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/06/2020] [Indexed: 01/24/2023]
Abstract
Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence, given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 pandemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe; thus, caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety relief. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).
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Affiliation(s)
- H Javelot
- Établissement Public de Santé Alsace Nord, Brumath, France; Laboratoire de toxicologie et pharmacologie neuro cardiovasculaire, université de Strasbourg, Strasbourg, France.
| | - L Weiner
- Clinique de psychiatrie, CHU de Strasbourg, Strasbourg, France; Laboratoire de psychologie des cognitions, université de Strasbourg, Strasbourg, France
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10
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Lin J, Wang Z, Qiu C, Wang Z, Jiang S, Tang H, Wang X, Qiu Z, He Y, Zhao J, Shi G, Sun S, Wang L, Chen L, Wang J, Mao A. A multicenter, prospective, observational study on montelukast monotherapy or montelukast-based combinations treating cough variant asthma. J Thorac Dis 2020; 12:6573-6585. [PMID: 33282359 PMCID: PMC7711367 DOI: 10.21037/jtd-20-1989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Evidence of treatment against cough variant asthma (CVA) is insufficient for the clinical practice in China. We aimed at evaluating the real-world effectiveness of montelukast (MONT) alone or in combination with low-dose inhaled corticosteroids (ICS) and low-dose ICS plus long-acting beta-2-agonists (LABA) for Chinese CVA patients in a multicentre, prospective, cohort study. Methods Adult patients diagnosed with CVA defined as chronic cough >8 weeks with a positive bronchial provocation test and normal chest X-ray findings were enrolled at respiratory clinics. Study treatment followed routine clinical practice. The investigators initiated MONT by 10 mg/day alone or in combination with a low-dose ICS +/− LABA and followed up treatment outcomes for 4 weeks. The primary outcome measure was the change in cough score (CS) from baseline. Results The study enrolled 247 patients (MONT =146, MONT + ICS =38, MONT + ICS/LABA =63). In the primary analysis, the mean change (95% CI) in CS at the end of the study was −1.2 (−1.6, −0.9), −0.9 (−1.5, −0.4), and −1.3 (−1.7, −0.8) in the three groups, respectively. MONT monotherapy had a satisfactory rate of weekly asthma control at the end of the study (83.5%, 95% CI: 75.1%, 89.4%) in the per-protocol analysis. Rates of weekly asthma control were similar in two MONT-based combination regimens (83.9%, 81.4%). Short-acting beta-2-agonist (SABA) user (≥2 times per week) was 16.8% in the MONT group. Conclusions The real-world effectiveness of MONT alone or in combination with ICS or ICS and LABA was acceptable for CVA short-term control.
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Affiliation(s)
- Jiangtao Lin
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Zaiyi Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Chen Qiu
- Department of Pulmonary and Critical Care Medicine, Shenzhen People's Hospital, Shenzhen, China
| | - Zhen Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shanping Jiang
- Department of Pulmonary and Critical Care Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Huaping Tang
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, Qingdao, China
| | - Xuefen Wang
- Department of Respiratory, The First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Zhongmin Qiu
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yong He
- Department of Pulmonary and Critical Care Medicine, Daping Hospital, Amy Military Medical University, Chongqing, China
| | - Jianping Zhao
- Department of Pulmonary and Critical Care Medicine, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Guochao Shi
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shenghua Sun
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Limin Wang
- Department of Pulmonary and Critical Care Medicine, Hangzhou First People's Hospital, Hangzhou, China
| | - Lin Chen
- Global Medical Affairs, Merck Research Laboratories, MSD China, Shanghai, China
| | - Jue Wang
- Global Medical Affairs, Merck Research Laboratories, MSD China, Shanghai, China
| | - Annhua Mao
- Global Medical Affairs, Merck Research Laboratories, MSD China, Shanghai, China
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11
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Simultaneous determination of nine constituents by validated UFLC-MS/MS in the plasma of cough variant asthma rats and its application to pharmacokinetic study after oral administration of Huanglong cough oral liquid. J Pharm Biomed Anal 2020; 193:113726. [PMID: 33171336 DOI: 10.1016/j.jpba.2020.113726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/19/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022]
Abstract
Huanglong cough oral liquid (HL), an important traditional Chinese medicine prescription for treating pediatric cough variant asthma (CVA) in Nanjing hospital of traditional Chinese medicine for many years. In this study, a selective, accurate and sensitive ultra fast liquid chromatography extreme resolution coupled with mass spectrometer (UFLC-MS/MS) method was established and validated for the simultaneous determination of nine constituents including morusin, ephedrine, praeruptorin A, praeruptorin B, luteolin, rosmarinic acid, quercetin, amygdalin, caffeic acid in CVA rat plasma sensitized and challenged with ovalbumin and cinnamaldehyde. Plasma samples were prepared by protein precipitation with four-fold amount of methanol. UFLC separation was performed on a Thermo Scientific AcclaimTM RSLC 120 C18 column (2.1 mm × 100 mm, 2.2 μm) with mobile phase containing methanol and 0.1% formic acid-water by gradient elution in 8.1 min at total flow of 0.3 mL/min. The determination of target compounds in plasma was operated by multiple reaction monitoring (MRM) mode with positive and negative electrospray ionization (ESI) source. The correlation coefficients (r) of all compounds were from 0.9930 to 0.9994 in the linear range. Lower limit of quantification (LLOQ, ng/mL) was 0.81, 2.01, 2.11, 1.17, 1.04, 0.89, 0.67, 1.45 and 0.59 for morusin, ephedrine, praeruptorin A, praeruptorin B, luteolin, rosmarinic acid, quercetin, amygdalin and caffeic acid, respectively. Intra- and inter-day accuracy and precision, extraction recovery, matrix effect, carryover effect, dilution integrity, and stability were within the limits specified. The established method was effectively applied to a pharmacokinetic study of the nine compounds in CVA rat plasma following oral administration HL exact (7.5, 15, 30 g/kg).
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12
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Yan F, Li W, Guan WJ, Chen M, Qiu C, Tang W, Liu X, Xiang X, Li J, Jin M, Dai Y, Chen P, Wu X, Qiu Z, Dong L, Zhao L, Lin X, Wu C, Wu B, Yuan Y, Shi F, Zhang T, Zhou J, Xie M, Fang X, Zhang H, Xiao B, Xian M, Wang J, Qiu Z, Lin J, Ji B, Zhou Y, Li Y, Liu C, Chen Y, Zeng Y, Liu L, Hua W, Huang H, Zhou J, Hu Y, Che L, Ying S, Chen Z, Zhong N, Shen H. Response of patients with chest tightness variant asthma with routine asthma treatment regimen: A 1-year multicenter, prospective, real-world study. Clin Transl Med 2020; 10:e178. [PMID: 32997402 PMCID: PMC7503098 DOI: 10.1002/ctm2.178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/01/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022] Open
Abstract
Background Asthmatic patients with chest tightness as their only presenting symptom (chest tightness variant asthma [CTVA]) have clinical characteristics of eosinophilic airway inflammation similar to those of classic asthma (CA); however, whether CTVA has similar response to antiasthma treatment as compared with CA remains unclear. Objective The response of 76 CTVA patients to standard asthma treatments with inhaled corticosteroids with long‐acting beta‐agonists was explored in a 52‐week multicenter, prospective, real‐world study. Results After 52 weeks of treatment with therapy regimens used for CA, the mean 5‐point Asthma Control Questionnaire (ACQ‐5) score decreased markedly from 1.38(first administration) to 0.71 (52 weeks, mean decrease: 0.674, 95%CI: 0.447‐0.900, P<.001).The mean asthma quality‐of‐life questionnaire (AQLQ) score increased from 5.77 (first administration) to 6.20 (52 weeks, mean increase: 0.441, 95% CI 0.258‐0.625, P<.001). Furthermore, at week 52, FVC, FEV1%, the diurnal variation in PEFand the PD20‐FEV1 were significantly improved. Subgroup analysis revealed that the patients at first administration in the responsive group had higher ACQ‐5 scores than those in the nonresponsive group (P < .05). Conclusion In conclusion, patients with CTVA had a good therapeutic response to the guideline‐recommended routine treatment (containing inhaled corticosteroids). The association between the treatment response and the severity of CTVA suggested that CTVA patients with higher ACQ‐5 scores had better therapeutic effects.
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Affiliation(s)
- Fugui Yan
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wen Li
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Wei-Jie Guan
- Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute for Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Chen
- Department of Respiratory Medicine, Affiliated Hospital, Guangdong Medical University, Zhanjiang, China
| | - Chen Qiu
- Department of Respiratory Medicine, Shenzhen People's Hospital, Shenzhen, China
| | - Wei Tang
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiansheng Liu
- Department of Respiratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xudong Xiang
- Department of Respiratory Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Jing Li
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Hospital, Guangzhou Medical University, Guangzhou, China
| | - Meiling Jin
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanrong Dai
- Department of Pulmonary Medicine, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ping Chen
- Department of Pulmonary Medicine, General Hospital of Northern Theater Command of the Chinese People's Liberation Army, Shenyang, China
| | - Xiaohong Wu
- Department of Pulmonary Medicine, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhongmin Qiu
- Department of Pulmonary Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liang Dong
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Limin Zhao
- Department of Pulmonary Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoping Lin
- Department of Pulmonary Medicine, Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Changgui Wu
- Department of Respiratory Disease, Xijing Hospital, The Fourth Military Medical University, Xian, China
| | - Bin Wu
- Department of Respiratory Medicine, Affiliated Hospital, Guangdong Medical University, Zhanjiang, China
| | - Yalian Yuan
- Department of Respiratory Medicine, Affiliated Hospital, Guangdong Medical University, Zhanjiang, China
| | - Fei Shi
- Department of Respiratory Medicine, Shenzhen People's Hospital, Shenzhen, China
| | - Ting Zhang
- Department of Respiratory Medicine, Shenzhen People's Hospital, Shenzhen, China
| | - Jun Zhou
- Department of Respiratory Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Min Xie
- Department of Respiratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyu Fang
- Department of Respiratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongliang Zhang
- Department of Respiratory Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Bing Xiao
- Department of Respiratory Medicine, Second Xiangya Hospital, Central South University, Changsha, China
| | - Mo Xian
- Department of Allergy and Clinical Immunology, Guangzhou Institute of Respiratory Health, The First Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jian Wang
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhangwei Qiu
- Department of Pulmonary Medicine, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Lin
- Department of Pulmonary Medicine, Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bingbing Ji
- Department of Pulmonary Medicine, General Hospital of Northern Theater Command of the Chinese People's Liberation Army, Shenyang, China
| | - Yong Zhou
- Department of Pulmonary Medicine, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yu Li
- Department of Pulmonary Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chunhong Liu
- Department of Pulmonary Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Yiping Chen
- Department of Pulmonary Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yiming Zeng
- Department of Pulmonary Medicine, Second Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Lingli Liu
- Department of Respiratory Disease, Xijing Hospital, The Fourth Military Medical University, Xian, China
| | - Wen Hua
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Huaqiong Huang
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jiesen Zhou
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yue Hu
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Luanqing Che
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Songmin Ying
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Zhihua Chen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Nanshan Zhong
- Department of Respiratory Medicine, State Key Laboratory of Respiratory Disease, Guangzhou Institute for Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Huahao Shen
- Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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13
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Javelot H, Weiner L. [Panic and pandemic: Review of the literature on the links between panic disorder and the SARS-CoV-2 epidemic]. L'ENCEPHALE 2020; 46:S93-S98. [PMID: 32507556 PMCID: PMC7241353 DOI: 10.1016/j.encep.2020.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/17/2020] [Indexed: 12/15/2022]
Abstract
Although the "panic" word has been abundantly linked to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic in the press, in the scientific literature very few studies have considered whether the current epidemic could predispose to the onset or the aggravation of panic attacks or panic disorder. Indeed, most studies thus far have focused on the risk of increase and aggravation of other psychiatric disorders as a consequence of the SARS-CoV-2 epidemic, such as obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). Yet, risk of onset or aggravation of panic disorder, especially the subtype with prominent respiratory symptoms, which is characterized by a fear response conditioning to interoceptive sensations (e.g., respiratory), and hypervigilance to these interoceptive signals, could be expected in the current situation. Indeed, respiratory symptoms, such as coughs and dyspnea, are among the most commonly associated with the SARS-CoV-2 (59-82% and 31-55%, respectively), and respiratory symptoms are associated with a poor illness prognosis. Hence given that some etiological and maintenance factors associated with panic disorder - i.e., fear conditioning to abnormal breathing patterns attributable or not to the COVID-19 (coronavirus disease 2019), as well as hypervigilance towards breathing abnormalities - are supposedly more prevalent, one could expect an increased risk of panic disorder onset or aggravation following the COVID-19 epidemic in people who were affected by the virus, but also those who were not. In people with the comorbidity (i.e., panic disorder or panic attacks and the COVID-19), it is particularly important to be aware of the risk of hypokalemia in specific at-risk situations or prescriptions. For instance, in the case of salbutamol prescription, which might be overly used in patients with anxiety disorders and COVID-19, or in patients presenting with diarrhea and vomiting. Hypokalemia is associated with an increased risk of torsade de pointe, thus caution is required when prescribing specific psychotropic drugs, such as the antidepressants citalopram and escitalopram, which are first-line treatments for panic disorder, but also hydroxyzine, aiming at anxiety reduction. The results reviewed here highlight the importance of considering and further investigating the impact of the current pandemic on the diagnosis and treatment of panic disorder (alone or comorbid with the COVID-19).
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Affiliation(s)
- H Javelot
- Établissement Public de Santé Alsace Nord (EPSAN), Brumath, France; Laboratoire de toxicologie et pharmacologie neurocardiovasculaire, université de Strasbourg, Strasbourg, France.
| | - L Weiner
- Clinique de psychiatrie, CHU de Strasbourg, Strasbourg, France; Laboratoire de psychologie des cognitions, université de Strasbourg, Strasbourg, France
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14
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Khosravani V, Samimi Ardestani SM, Alvani A, Amirinezhad A. Alexithymia, empathy, negative affect and physical symptoms in patients with asthma. Clin Psychol Psychother 2020; 27:736-748. [PMID: 32285550 DOI: 10.1002/cpp.2458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 02/07/2023]
Abstract
Although alexithymia has been found to be associated with physical symptoms in psychosomatic disorders such as asthma, mechanisms linking this association are unknown. However, affective alexithymic features may be associated with physical symptoms in the presence of deficits in affective characteristics such as low empathy and high negative affect. This study aimed to assess direct effects of alexithymic traits on physical symptoms and indirect effects of these subscales through empathy and negative affect (e.g. depressive, anxious and stress symptoms) by controlling for asthma severity in patients with asthma. Three hundred patients with asthma completed the Toronto Alexithymia Scale-20 (TAS-20), the Basic Empathy Scale (BES), the Depression Anxiety Stress Scales-21 (DASS-21) and the Physical Symptoms Inventory (PSI). After controlling for asthma severity, the results showed that alexithymia subscales of the TAS-20 had no direct effects on physical symptoms, but the difficulty in identifying feelings (DIF) subscale of the TAS-20 was associated with affective empathy and negative affect. Affective empathy was significantly related to negative affect. Affective empathy and negative affect were associated with physical symptoms. The affective subscale of alexithymia on the TAS-20, that is DIF, indirectly affected physical symptoms through affective empathy and negative affect. Findings suggest that patients with asthma who have high levels of DIF may show high physical symptoms in the presence of low affective empathy and high negative affect.
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Affiliation(s)
- Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mehdi Samimi Ardestani
- Department of Psychiatry, Behavioral Sciences Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Alvani
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Amirinezhad
- Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran
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Sun X, Yang W, Gong S, Liang S, Gu S, Lu H, Liu J, Xu J. Diagnostic value of volumetric capnography in patients with chronic cough variant asthma. Clinics (Sao Paulo) 2020; 75:e1662. [PMID: 33084765 PMCID: PMC7536889 DOI: 10.6061/clinics/2020/e1662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/12/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the quantitative changes and diagnostic performance of volumetric capnography (VCap) parameters in patients with cough variant asthma. METHODS This cross-sectional study enrolled 31 patients with cough variant asthma and 30 patients with chronic cough without asthma between November 2010 and March 2012. VCap measurements were recorded at baseline, during the five steps of the histamine challenge, and after bronchodilation with salbutamol. They were then compared between the baseline and histamine challenge, and between the two groups. Receiver operating characteristic curve analysis was performed for different VCap measurements. RESULTS The slope of phase III (dc\dv3) and the ratio of phase III slope to phase II slope (SR23%) decreased from baseline upon challenge with 1.1 mg histamine in cough variant asthma patients but increased in patients with chronic cough without asthma. Additionally, the change upon challenge with 1.1 mg histamine in dc\dv3 from baseline (S6-S1dc\dv3) in cough variant asthma patients had the largest area under the curve (AUC) (0.814, 95% CI: 0.697-0.931; p<0.001). The AUC for change upon challenge with 1.1 mg histamine in SR23% from baseline was 0.755 (95%CI: 0.632-0.878; p<0.001). At a cutoff of 19.8, S6-S1 dc\dv3 had a sensitivity of 74.2% and specificity of 90.0% and at a cutoff of 40.7, S6-S1 SR23% had a sensitivity of 48.4% and specificity of 96.7%. CONCLUSION Patients with cough variant asthma exhibit distinct VCap responses for dead space parameters upon challenge with histamine in comparison to patients with chronic cough. VCap parameters like phase III slope and phase III/phase II slope ratio could be used to aid the diagnosis of cough variant asthma.
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Affiliation(s)
- Xiaoli Sun
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Wenlan Yang
- Department of Pulmonary Function Test, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Sugang Gong
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Shuo Liang
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Shuyi Gu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Haiwen Lu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Jinmin Liu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
| | - Jinfu Xu
- Department of Respiratory and Critical Care Medicine, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai 200433, China
- *Corresponding author. E-mail:
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Wang J, Sun R, Wang R, Han J, Zhang S, Yin Z, Han Z, Nong Y, Lin J. A traditional Chinese patent medicine-Suhuang zhike capsule for cough variant asthma in adults: A protocol of systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e18335. [PMID: 31852128 PMCID: PMC6922386 DOI: 10.1097/md.0000000000018335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Many people with cough variant asthma use Traditional Chinese Patent Medicine-Suhuang anti-tussive capsule to help reduce symptoms. However there is no systematic reviews had promising its efficacy and safety for cough variant asthma. METHODS Four English databases (PubMed, Web of science, EMBASE, and Springer Cochrane Library) and 4 Chinese databases (Wanfang Database, Chinese Scientific Journal Database, China National Knowledge Infrastructure Database, and Chinese Biomedical Literature Database) were researched for the randomized controlled trials of Suhuang anti-tussive capsule for cough variant asthma. The search was limited to human studies, using the search keywords or free-text terms "cough," "cough variant asthma," "Suhuang Zhike capsul,""Suhuang anti-tussive capsul," and "randomized clinical trials." Two reviewers individually extracted data from the included randomized controlled trials (RCTs). Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The primary outcomes include the frequency of asthma exacerbations during follow-up, asthmatic symptoms by validated instruments (including symptom scores, Likert scale, visual analogue scale). Lung function, serum immunoglobulin E, blood eosinophil count, phlegm eosinophil count, tumor necrosis factor-a, interleukin-1b, and adverse effects (numbers of participants experiencing each adverse events) will be assessed as the secondary outcome. Meta-analysis will be performed using RevMan5.3.5 software provided by the Cochrane Collaboration. RESULTS This study will provide high-quality synthesis based on current evidence of Suhuang anti-tussive capsule treatment for cough variant asthma. CONCLUSION This analysis will provide updated evidence for whether Suhuang anti-tussive capsule is an effective and safe intervention for cough variant asthma. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019139695.
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Affiliation(s)
- Jianxin Wang
- Beijing University of Chinese Medicine
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Rui Sun
- Beijing University of Chinese Medicine
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Ruiyin Wang
- Beijing University of Chinese Medicine
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Jing Han
- Beijing University of Chinese Medicine
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Shuhua Zhang
- Beijing University of Chinese Medicine
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Zetao Yin
- Beijing University of Chinese Medicine
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Zelu Han
- Beijing University of Chinese Medicine
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Ying Nong
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Jiangtao Lin
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Diseases, Beijing, China
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Qin W, Wu X, Jia Y, Tong X, Guo C, Chen D, Wang Z, Tan N. Suhuang antitussive capsule inhibits NLRP3 inflammasome activation and ameliorates pulmonary dysfunction via suppression of endoplasmic reticulum stress in cough variant asthma. Biomed Pharmacother 2019; 118:109188. [PMID: 31315072 DOI: 10.1016/j.biopha.2019.109188] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/10/2019] [Accepted: 06/28/2019] [Indexed: 12/17/2022] Open
Abstract
Pulmonary dysfunction is tightly associated with cough variant asthma (CVA), a respiratory damage disease. Suhuang antitussive capsule (Suhuang), one of traditional Chinese patent medicines, plays a crucial role in the treatment and complication of CVA in the long clinical application. In this study, we aimed to investigate the protective effects and underlying antitussive mechanisms of Suhuang on pulmonary function in ovalbumin (OVA)-induced CVA rats. Administration (i.g.) of Suhuang significantly alleviated pulmonary damage and dysfunction. Suhuang improved ER stress and PKCε translocation via regulation of Ca2+ trafficking. Suhuang also inhibited NLRP3 inflammasome activation, as evidenced by disrupting the assembly of NLRP3 inflammasome and reducing the expression of cleaved caspase-1, and decreased IL-1β secretion. Besides, it's identified that TXNIP induction and RIP1-RIP3-Drp1 pathway were required for the inhibitory routes of Suhuang from ER stress to NLRP3 inflammasome activation. Consistent with the in vivo findings, Suhuang also attenuated ER stress/NLRP3 inflammasome activation, and thereby restored pulmonary homeostasis in vitro. Meantime, these functions were diminished by blocking ER stress, indicating that ER stress is essential for the effects of Suhuang on pulmonary function. A further in vivo analysis showed that Suhuang-driven pharmacological inactivation of NLRP3 inflammasome and amelioration of pulmonary dysfunction were reversed by an ER stress inducer tunicamycin, well confirming the beneficial effects of Suhuang on pulmonary function by regulation of ER stress. Collectively, these results indicated that Suhuang contributed to impairing NLRP3 inflammasome activation via inhibition of ER stress, which was responsible for the protection of pulmonary homeostasis. These findings may provide a pharmacological groundwork and important new experimental data regarding the clinical treatment of Suhuang in CVA patients.
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Affiliation(s)
- Weiwei Qin
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, PR China
| | - Xingdong Wu
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, PR China
| | - Yuning Jia
- Yangtze River Pharmaceutical Group Beijing Haiyan Pharmaceutical Co., Ltd., Beijing 102206, PR China; Beijing University of Chemical Technology, Beijing 100029, PR China
| | - Xiyang Tong
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, PR China
| | - Chao Guo
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, PR China
| | - Dong Chen
- Yangtze River Pharmaceutical Group Beijing Haiyan Pharmaceutical Co., Ltd., Beijing 102206, PR China.
| | - Zhen Wang
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, PR China.
| | - Ninghua Tan
- State Key Laboratory of Natural Medicines, Department of TCMs Pharmaceuticals, School of Traditional Chinese Pharmacy, China Pharmaceutical University, Nanjing 211198, PR China.
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Farrell MJ, Mazzone SB. Are neural pathways processing airway inputs sensitized in patients with cough hypersensitivity? Pulm Pharmacol Ther 2019; 57:101806. [PMID: 31100512 DOI: 10.1016/j.pupt.2019.101806] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022]
Abstract
Patients with cough hypersensitivity exhibit unusually low thresholds for responses to tussive stimuli, exaggerated responses to suprathreshold tussive stimuli, and report spontaneous experiences of urge-to-cough in the absence of exogenous stimulation. These aberrant responses to tussive challenge have the hallmark features of behaviours associated with a sensitized sensory system. Searching for further evidence to implicate neural sensitization in the symptomatology of cough hypersensitivity warrants consideration. If up-regulation of neural circuits involved in processing of airways inputs can be demonstrated in patients with cough hypersensitivity, then strategies to reverse this dysfunctional plasticity can be contemplated and assessed. This review considers the implications of neural sensitization as a factor in the cough hypersensitivity syndrome, reflects on the limited data available in this field, and suggests prospective directions for future research.
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Affiliation(s)
- Michael J Farrell
- Department of Medical Imaging and Radiation Sciences, School of Public and Allied Health Care, Monash University, Clayton, VIC, 3800, Australia.
| | - Stuart B Mazzone
- Department of Anatomy and Neuroscience, The University of Melbourne, Parkville, VIC, 3010, Australia
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Wei H, Li W, Jiang Z, Xi X, Qi G. Clinical efficacy of montelukast sodium combined with budesonide or combined with loratadine in treating children with cough variant asthma and influence on inflammatory factors in the serum. Exp Ther Med 2019; 18:411-417. [PMID: 31258680 PMCID: PMC6566116 DOI: 10.3892/etm.2019.7574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/19/2019] [Indexed: 11/12/2022] Open
Abstract
Clinical efficacy of montelukast sodium combined with budesonide or combined with loratadine in children with cough variant asthma was investigated. A retrospective analysis of the medical records of 72 children with cough variant asthma who were treated in Xuzhou Children's Hospital, Xuzhou Medical University from April 2015 to August 2017 was performed and the 72 child patients were divided into two groups: 35 children were treated with montelukast sodium combined with budesonide in Group A, and 37 children were treated with montelukast sodium combined with loratadine in Group B. The clinical efficacy of the two groups was evaluated according to the lung function indexes [forced expiratory volume in the first second (FEV1), ratio of the forced expiratory volume in the first second to the forced vital capacity (FEV1/FVC), the peak expiratory flow (PEF)], the inflammation biomarkers [tumor necrosis factor-α (TNF-α) and interleukin-4 (IL-4)], the level of eosinophil granulocyte, and the level of IgE at three time-points: before treatment, the 4th week after treatment, and the 12th week after treatment as well as adverse reactions, recurrence of symptoms, and treatment compliance were recorded. After treatment, the levels of FEV1, FEV1/FVC, PEF, TNF-α and IL-4, eosinophil granulocyte and IgE in the two groups were significantly improved (P<0.05). The treatment compliance of Group A was significantly lower than that of Group B (P<0.05). In conclusion, the method of montelukast sodium combined with budesonide or loratadine are both worthy of clinical promotion because they have equivalent efficacy in the treatment of cough variant asthma to effectively improve the lung function and inflammatory response in patients and both bring less adverse reactions and lower recurrence rate.
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Affiliation(s)
- Haiyan Wei
- Department of Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Weihua Li
- Department of Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Zhen Jiang
- Department of Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Xiaoying Xi
- Department of Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
| | - Gongjian Qi
- Department of Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou Medical University, Xuzhou, Jiangsu 221006, P.R. China
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Fan RR, Wen ZH, Wang DW, Yang RY, Ou AH, Jin LS, Zhang ZD, Liu YT. Chinese herbal medicine for the treatment of cough variant asthma: a study protocol for a double-blind randomized controlled trial. Trials 2019; 20:3. [PMID: 30606237 PMCID: PMC6318874 DOI: 10.1186/s13063-018-3073-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/23/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cough variant asthma (CVA) is one of the leading causes of chronic coughing. The main treatment is currently anti-inflammatory medication. However, the coughing may return or be aggravated and lung function may deteriorate once the anti-inflammatory treatment is stopped. The effect of Chinese herbal medicine (CHM) on chronic coughing is remarkable, but high-quality evidence supporting its effectiveness is still lacking. This trial aims to evaluate the safety and efficacy, especially the long-term efficacy, of CHM plus anti-inflammatory medications for the treatment of CVA. METHODS/DESIGN A randomized placebo-controlled double-blind trial will be conducted. It will consist of a 3-month intervention followed by a 6-month follow-up period. The target sample size is 60 patients with CVA who are between 18 and 70 years old. The eligible subjects will be allocated randomly into the experimental or control group in a ratio of 1:1. Patients in the experimental group will take CHM granules (4.9 g twice daily), while patients in the control group will be given a matched placebo. An administration of salmeterol/fluticasone propionate combination for 12 weeks will be the basic therapy for the two groups. The primary outcome is the cough visual analog scales (CVAS). The secondary outcomes include quality of life, rate of symptom relapse, lung function, and blood tests. A safety assessment will also be performed during the trial. DISCUSSION The evidence gathered by the trial will be a valuable addition to informing treatment options for patients with CVA. TRIAL REGISTRATION http://www.chictr.org.cn , ID: ChiCTR-IOR-16009148. Registered on 3 September 2016.
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Affiliation(s)
- Rong-rong Fan
- The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, 510405 China
| | - Ze-huai Wen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 China
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510210 China
| | - Da-wei Wang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 China
- Lingnan Zhenshi Miscellaneous Diseases School, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120 China
| | - Rong-yuan Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 China
- Lingnan Zhenshi Miscellaneous Diseases School, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120 China
| | - Ai-hua Ou
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 China
| | - Lian-shun Jin
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 China
- Lingnan Zhenshi Miscellaneous Diseases School, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120 China
| | - Zhong-de Zhang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 China
- Lingnan Zhenshi Miscellaneous Diseases School, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120 China
| | - Yun-tao Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510120 China
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Cao Y, Lin SH, Zhu D, Xu F, Chen ZH, Shen HH, Li W. WeChat Public Account Use Improves Clinical Control of Cough-Variant Asthma: A Randomized Controlled Trial. Med Sci Monit 2018. [PMID: 29536984 PMCID: PMC5865451 DOI: 10.12659/msm.907284] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background WeChat is a convenient and popular social medium, and it seems to be an appropriate platform for education and management of patients. This study sought to identify usefulness in clinical control of cough-variant asthma (CVA). Material/Methods A randomized controlled trial was conducted among 80 CVA patients. After being assigned to either the traditional group (TG) or the WeChat group (WG), they received the same inhalation therapy, but patients in WG received additional education and instruction via our public account on the WeChat application. Questionnaires on asthma and chronic cough, data on pulmonary function, blood-related items, follow-up adherence, and Emergency Department (ED) visits were collected at the initial visit and at 3 months. Results A total of 67 participants completed the trial for analysis. FEV1/predicted and FEV1/FVC were significantly increased in WG (p<0.001; p=0.012) after 3 months. PD20-FEV1 was increased in both groups compared with baseline, but more pronounced in WG (p=0.004). ACQ-7 scores were improved in both groups (p=0.024; p<0.001). Participants allocated to WG experienced a greater improvement in AQLQ and LCQ scores, and between-group differences were significant at 3 months (p=0.040; p=0.001). Furthermore, we observed decreases in blood eosinophil count and FeNO in WG (p=0.048; p=0.014), and WG presented better follow-up compliance (p=0.034). Conclusions Using WeChat as part of treatment and management of CVA can help patients learn about their disease and medications, as well as improve disease control and therapy outcomes.
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Affiliation(s)
- Yuan Cao
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Shi-Hua Lin
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Ding Zhu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Feng Xu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Zhi-Hua Chen
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Hua-Hao Shen
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
| | - Wen Li
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland)
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Abstract
OBJECTIVE Studies show high comorbidity of mood disorders in asthma. As asthma is a highly heterogeneous disease with different phenotypes it can be expected that there is a difference in this association with different asthma phenotypes. The aim of our cross-sectional study was to assess the association of specific asthma phenotypes with anxiety and/or depression and their impact on asthma control. METHODS A cross-sectional study in 201 consecutive adult outpatients with asthma (≥18 years of age) was conducted. Each patient underwent physical examination, detailed medical history, Hospital Anxiety and Depression Scale, Asthma Control Questionnaire, Asthma Control Test, together with measurements of lung function and fraction of exhaled nitric oxide. Phenotypes were assessed using cluster analysis, and a multivariate analysis was used to identify associations of mood disorders with different phenotypes. RESULTS Five asthma phenotypes were identified: allergic (AA, 43.8%), aspirin-exacerbated respiratory disease (AERD, 21.9%), late-onset (LOA, 18.9%), obesity-associated (OAA, 10.0%), and respiratory infections associated asthma (RIAA, 5.5%). A multivariate analysis showed a significant association of anxiety with LOA and comorbid hypertension (LOA, odds ratio (OR) = 2.12; hypertension, OR = 2.37, p = 0.012), and depression with AA, RIAA, hypertension, and ACQ score (AA, OR = 6.07; RIAA, OR = 4.73; hypertension, OR = 5.67; ACQ, OR = 1.87; p < 0.001). Comorbid anxiety/depression was associated with AA, LOA, RIAA, hypertension, and ACQ score (AA, OR = 10.15; LOA, OR = 2.98; RIAA, OR = 6.29; hypertension, OR = 5.15; ACQ, OR = 1.90; p < 0.001. CONCLUSION Mood disorders were significantly associated with AA, LOA, and infection-associated asthma, together with comorbid hypertension and the level of asthma control.
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Affiliation(s)
- Marina Labor
- a Department of Pulmonology , University Hospital Center Osijek , Osijek , Croatia.,b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia
| | - Slavica Labor
- a Department of Pulmonology , University Hospital Center Osijek , Osijek , Croatia.,b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia
| | - Iva Jurić
- c Department of Medicine , University Hospital Center Osijek , Osijek , Croatia
| | - Vladimir Fijačko
- a Department of Pulmonology , University Hospital Center Osijek , Osijek , Croatia.,b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia
| | - Sanja Popović Grle
- d Department of Pulmonology , University Hospital Center Zagreb , Zagreb , Croatia
| | - Davor Plavec
- b Faculty of Medicine , J.J. Strossmayer University of Osijek , Osijek , Croatia.,e Research Department , Children's Hospital Srebrnjak , Zagreb , Croatia
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Ciprandi G, Schiavetti I, Rindone E, Ricciardolo FLM. The impact of anxiety and depression on outpatients with asthma. Ann Allergy Asthma Immunol 2015; 115:408-14. [PMID: 26392047 DOI: 10.1016/j.anai.2015.08.007] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 08/03/2015] [Accepted: 08/12/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Anxiety and depression may frequently affect patients with asthma. However, the findings of several studies are partially conflicting and conducted in selected cohorts. OBJECTIVE To investigate the effect of anxiety and depression in a group of outpatients with asthma. METHODS This cross-sectional, real-life study included 263 patients (109 males; mean age, 39.2 years) with asthma. Clinical examination, lung function, fractional exhaled nitric oxide measurement, Asthma Control Test (ACT) score, asthma control grade, perception of symptoms by visual analog scale, and Hospital Anxiety and Depression Scale (HADS) questionnaires were evaluated. RESULTS Globally, 97 patients (36.9%) had anxiety, and 29 (11%) had depression. Of these patients, 71 had combined anxiety and depression. Anxiety and depression were associated with poor asthma control (P =.007 and .02, respectively). Patients with depression had higher body mass indexes (P =.002). Anxiety and depression were associated with lower ACT scores (P < .001 for both). The scores on the anxiety and depression subscales of HADS were moderately related (r = 0.57). CONCLUSIONS The present real-life study indicates that anxiety and depression are common and relevant comorbidities in asthmatic outpatients and are associated with uncontrolled asthma and lower ACT scores. Thus, assessment of comorbid mental disorders should be performed in common practice.
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Affiliation(s)
- Giorgio Ciprandi
- Department of Medicine, IRCCS - Azienda Ospedaliera Universitaria San Martino, Genoa, Italy.
| | | | - Elena Rindone
- Division of Respiratory Disease, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
| | - Fabio L M Ricciardolo
- Division of Respiratory Disease, Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
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Dicpinigaitis PV. Letter to the Editor on Saito et al., "Cough variant asthma patients are more depressed and anxious than classic asthma patients.". J Psychosom Res 2015; 79:88. [PMID: 25959711 DOI: 10.1016/j.jpsychores.2015.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 04/17/2015] [Accepted: 04/18/2015] [Indexed: 11/30/2022]
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